Cost-effectiveness analysis of nivolumab-chemotherapy as first-line therapy for locally advanced/metastatic gastric cancer: a United States payer perspective

ABSTRACT

Objectives

Nivolumab, an immune checkpoint inhibitor, was approved by the United States (US) Food and Drug administration as a first-line systemic therapy for locally advanced/metastatic gastric cancer patients. The current study aimed to investigate the cost-effectiveness of nivolumab-chemotherapy combination versus chemotherapy alone as a first-line therapy from a US payer perspective.

Methods

An economic evaluation was conducted using a partitioned survival model in Microsoft Excel® using data from the CheckMate 649 trial. Three discrete mutually exclusive health states (progression-free, post-progression, and death) were included in the model. The health state occupancy was calculated using the overall survival and progression-free survival curves derived from the CheckMate 649 trial. Cost, resource use, and health utility estimates were estimated from a US payer perspective. Deterministic and probabilistic sensitivity analyses assessed the uncertainty of the model parameters.

Results

Nivolumab-chemotherapy provided additional 0.25 life years compared to chemotherapy alone and the quality-adjusted life years (QALYs) were 0.701 and 0.561, respectively, producing a gain of 0.140 QALYs and an incremental cost-effectiveness ratio of $574,072/QALY.

Conclusion

From the US payer perspective, at a willingness to pay threshold of $US150,000/QALY, nivolumab-chemotherapy was not found to be cost-effective as a first-line therapy for locally advanced/metastatic gastric cancer.

KEYWORDS:

• gastric cancer
• nivolumab
• cost-effectiveness
• trial
• metastatic

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Conceptualization, S Marupuru; M Yaghoubi, and T Warholak; methodology, S Marupuru; D Arku; M Yaghoubi; software, S Marupuru; validation, S Marupuru, D Arku, D Axon, L Villa-Zapata, M Slack, M Yaghoubi, and T Warholak; formal analysis, S Marupuru; D Arku; investigation S Marupuru; D Arku; resources, D Axon, L Villa-Zapata, M Slack, M Yaghoubi, and T Warholak; data curation, S Marupuru; D Arku; writing – original draft preparation, S Marupuru; D Arku; writing – review and editing, S Marupuru; D Arku; visualization, S Marupuru; supervision, D Axon, L Villa-Zapata, M Slack, M Yaghoubi, and T Warholak; project administration, D Axon, L Villa-Zapata, M Slack, M Yaghoubi, and T Warholak. All authors have read and agreed to the published version of the manuscript.

Additional information

Funding

This paper was not funded.