title: Economic evaluation of nivolumab for the treatment of second-line advanced squamous NSCLC in Canada: a comparison of modeling approaches to estimate and extrapolate survival outcomes.
abstract: Background Lung cancer is the most common type of cancer in the world and is associated with significant mortality. Nivolumab demonstrated statistically significant improvements in progression-free survival (PFS) and overall survival (OS) for patients with advanced squamous non-small cell lung cancer (NSCLC) who were previously treated. The cost-effectiveness of nivolumab has not been assessed in Canada. A contentious component of projecting long-term cost and outcomes in cancer relates to the modeling approach adopted, with the two most common approaches being partitioned survival (PS) and Markov models. The objectives of this analysis were to estimate the cost-utility of nivolumab and to compare the results using these alternative modeling approaches. Methods Both PS and Markov models were developed using docetaxel and erlotinib as comparators. A three-health state model was used consisting of progression-free, progressed disease, and death. Disease progression and time to progression were estimated by identifying best-fitting survival curves from the clinical trial data for PFS and OS. Expected costs and health outcomes were calculated by combining health-state occupancy with medical resource use and quality-of-life assigned to each of the three health states. The health outcomes included in the model were survival and quality-adjusted-life-years (QALYs). Results Nivolumab was found to have the highest expected per-patient cost, but also improved per-patient life years (LYs) and QALYs. Nivolumab cost an additional $151,560 and $140,601 per QALY gained compared to docetaxel and erlotinib, respectively, using a PS model approach. The cost-utility estimates using a Markov model were very similar ($152,229 and $141,838, respectively, per QALY gained). Conclusions Nivolumab was found to involve a trade-off between improved patient survival and QALYs, and increased cost. It was found that the use of a PS or Markov model produced very similar estimates of expected cost, outcomes, and incremental cost-utility.
authors: a Goeree Consulting Limited , Hamilton , Ontario , Canada ;|b McMaster University , Hamilton , Ontario , Canada ;
authors: Ron
authors: R
authors: Goeree
authors: c Bristol-Myers Squibb Canada , Saint-Laurent , Quebec , Canada ;
authors: Julie
authors: J
authors: Villeneuve
authors: a Goeree Consulting Limited , Hamilton , Ontario , Canada ;
authors: Jeff
authors: J
authors: Goeree
authors: d Bristol-Myers Squibb , Princeton , New Jersey , USA ;
authors: John R
authors: JR
authors: Penrod
authors: d Bristol-Myers Squibb , Princeton , New Jersey , USA ;
authors: Lucinda
authors: L
authors: Orsini
authors: c Bristol-Myers Squibb Canada , Saint-Laurent , Quebec , Canada ;|e Department of Epidemiology, Biostatistics and Occupational Health , McGill University , Montreal , Quebec , Canada.
authors: Amir Abbas
authors: AA
authors: Tahami Monfared
mesh_terms: D000911:Antibodies, Monoclonal / Q000191:economics* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D019468:Disease Management; D018572:Disease-Free Survival; D000077143:Docetaxel; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality; D017059:Models, Econometric; D015233:Models, Statistical; D000077594:Nivolumab; D019057:Quality-Adjusted Life Years; D043823:Taxoids / Q000191:economics / Q000627:therapeutic use; D013727:Terminal Care / Q000191:economics
chemical_list: D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D043823:Taxoids; D000077143:Docetaxel; D000077594:Nivolumab
keywords: Economic evaluation; Markov model; Nivolumab; Partitioned survival model; Squamous non-small cell lung cancer; Structural uncertainty