A Cost-Effectiveness Analysis of Nivolumab versus Docetaxel for Advanced Nonsquamous NSCLC Including PD-L1 Testing.
Nivolumab (NIV) was recently approved in several countries for patients with pretreated advanced NSCLC. NIV is not cost-effective compared with docetaxel (DOC) for the treatment of squamous NSCLC. However, its cost-effectiveness for nonsquamous NSCLC and the consequences of programmed death ligand 1 (PD-L1) testing are unknown.



This literature-based health economic study used CheckMate-057 trial data to model the incremental cost-effectiveness ratio (ICER) of NIV versus DOC in the Swiss health care setting. The effect of PD-L1 positivity for patient selection was assessed.



In the base case model, NIV (mean cost CHF66,208; mean effect 0.69 quality-adjusted life-years [QALYs]) compared with DOC (mean cost CHF37,618; mean effect 0.53 QALYs) resulted in an ICER of CHF177,478/QALY gained. Treating only patients with PD-L1-positive tumors (threshold ≥10%) with NIV compared with treating all patients with DOC produced a base case ICER of CHF124,891/QALY gained. Reduced drug price, dose, or treatment duration decreased the ICER partly below a willingness-to-pay threshold of CHF100,000/QALY. Health state utilities strongly influenced cost-effectiveness.



Compared with DOC, NIV is not cost-effective for the treatment of nonsquamous NSCLC at current prices in the Swiss health care setting. Price reduction or PD-L1 testing and selection of patients for NIV on the basis of test positivity improves cost-effectiveness compared with DOC.
Swiss Group for Clinical Cancer Research Coordinating Centre, Bern, Switzerland; Institute of Pharmaceutical Medicine, University of Basel, Basel, Switzerland. Electronic address: Klazien.Matter@unibas.ch.
Klazien
K
Matter-Walstra
Institute of Pharmaceutical Medicine, University of Basel, Basel, Switzerland.
Matthias
M
Schwenkglenks
Swiss Group for Clinical Cancer Research Coordinating Centre, Bern, Switzerland; Medical Oncology, Department of Internal Medicine, Cantonal Hospital Lucerne, Lucerne, Switzerland.
Stefan
S
Aebi
Department of Gynaecology, University Hospital Zürich, Zürich, Switzerland.
Konstantin
K
Dedes
Institute of Pathology, Cantonal Hospital Lucerne, Spitalstrasse, CH-6000 Lucerne, Switzerland.
Joachim
J
Diebold
Medical Controlling, Cantonal Hospital Lucerne, Lucerne, Switzerland.
Mario
M
Pietrini
Swiss Group for Clinical Cancer Research Coordinating Centre, Bern, Switzerland.
Dirk
D
Klingbiel
Swiss Group for Clinical Cancer Research Coordinating Centre, Bern, Switzerland; Medical Oncology, Cantonal Hospital Graubünden, Chur, Switzerland.
Roger
R
von Moos
Swiss Group for Clinical Cancer Research Coordinating Centre, Bern, Switzerland; Medical Oncology, Department of Internal Medicine, Cantonal Hospital Lucerne, Lucerne, Switzerland.
Oliver
O
Gautschi
D000911:Antibodies, Monoclonal / Q000191:economics* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D060890:B7-H1 Antigen / Q000378:metabolism*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology; D003362:Cost-Benefit Analysis; D000077143:Docetaxel; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D000077594:Nivolumab; D019057:Quality-Adjusted Life Years; D043823:Taxoids / Q000191:economics* / Q000627:therapeutic use
D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D060890:B7-H1 Antigen; C423236:CD274 protein, human; D043823:Taxoids; D000077143:Docetaxel; D000077594:Nivolumab
Cost-effectiveness; Docetaxel; ICER; Lung cancer; Nivolumab; QALY