A Cost-Effectiveness Analysis of Nivolumab versus Docetaxel for Advanced Nonsquamous NSCLC Including PD-L1 Testing
A Cost-Effectiveness Analysis of Nivolumab versus Docetaxel for Advanced Nonsquamous NSCLC Including PD-L1 Testing
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DOI：
10.1016/j.jtho.2016.05.032
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发表时间：
2016-11-01
影响因子：
20.4
通讯作者：
Gautschi, Oliver
中科院分区：
文献类型：
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作者：
Matter-Walstra, Klazien;Schwenkglenks, Matthias;Gautschi, Oliver
简介：纳武单抗 (NW) 最近在多个国家获批用于治疗已接受过治疗的晚期 NSCLC 患者。与多西他赛 (DOC) 相比，NIV 治疗鳞状 NSCLC 的成本效益不高。然而，其对非鳞状 NSCLC 的成本效益以及程序性死亡配体 1 (PD-L1) 检测的后果尚不清楚。 方法：这项基于文献的健康经济学研究使用 CheckMate-057 试验数据来模拟瑞士医疗机构中 NIV 与 DOC 的增量成本效益比 (ICER)。评估了 PD-L1 阳性对患者选择的影响。结果：在基本案例模型中，与 DOC（平均成本 CHF37,618；平均效果 0.53 QALY）相比，NIV（平均成本 CHF66,208；平均效果 0.69 质量调整生命年 [QALY]）导致 ICER 增加为 CHF177,478/QALY。与使用 DOC 治疗所有患者相比，仅使用 NIV 治疗 PD-L1 阳性肿瘤（阈值 >= 10%）的患者产生了 CHF124,891/QALY 的基本情况 ICER。药物价格、剂量或治疗持续时间的降低使 ICER 部分降低至 CHF100,000/QALY 的支付意愿门槛以下。健康状况公用事业对成本效益影响很大。结论：与 DOC 相比，在瑞士医疗保健环境中，以当前价格计算，NIV 对于非鳞状 NSCLC 的治疗并不具有成本效益。与 DOC 相比，PD-L1 检测的价格降低以及根据检测阳性选择 NIV 患者可提高成本效益。 (C) 2016 年国际肺癌研究协会。由爱思唯尔公司出版。保留所有权利。
Introduction: Nivolumab (NW) 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.Methods: 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.Results: 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.Conclusions: 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. (C) 2016 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.