Cost-effectiveness of nivolumab monotherapy in the third-line treatment of small cell lung cancer.

Abstract

AIMS\nPresent cost-effectiveness analysis of nivolumab monotherapy vs commonly prescribed third-line (3L+) treatment in small cell lung cancer (SCLC).\n\n\nMATERIALS AND METHODS\nA three health states partitioned survival model (progression-free, progressed disease, and death; US payer perspective) was developed. Systematic literature review identified no randomized controlled or single-arm trials with separate outcomes for 3L\u2009+\u2009SCLC patients. Topotecan was chosen as comparator because it is frequently prescribed in real-world practice for 3L SCLC. Clinical inputs for topotecan were derived from the Flatiron database with inclusion/exclusion criteria matched to patients treated with 3L\u2009+\u2009nivolumab in CheckMate 032. Intravenous (IV) and oral topotecan clinical efficacy were assumed equivalent. Base-case analysis used a 20-year lifetime horizon. An annual discount rate of 3.0% for costs and outcomes was applied. Uncertainty was assessed using sensitivity analyses adjusted for key parameters.\n\n\nRESULTS\nIncremental cost per quality-adjusted life-year (QALY) gained with nivolumab was US$153,312 vs IV topotecan and US$123,003 vs oral topotecan, respectively. When results were disaggregated, nivolumab-related costs were mainly driven by drug acquisition costs, and topotecan-related costs were primarily due to adverse event treatment. Mean overall survival (OS) was 21.69 months with nivolumab and 5.80 months with IV or oral topotecan. More favorable outcomes were found by the landmark response analyses. Deterministic sensitivity analyses showed that changes to the discount rate for costs and outcomes and body weight had the greatest impacts on results.\n\n\nLIMITATIONS\nIncluded use of real-world data for OS outcomes associated with 3L topotecan, use of second-line topotecan data for progression-free survival, and no indirect costs.\n\n\nCONCLUSIONS\nBased on the literature on willingness-to-pay for a QALY in metastatic cancer, nivolumab monotherapy might represent a cost-effective option for 3L\u2009+\u2009treatment of SCLC compared with IV and oral topotecan. Sensitivity analysis using response-based methods yielded further favorable cost-effectiveness estimates.