Efficiency of nivolumab in the treatment of second-line advanced non-squamous non-small cell lung cancer (NSCLC) in Spain

Abstract

Background: The aim was to estimate the cost per life year gained (LYG) and qualityadjusted life year (QALY) of nivolumab compared to the standard of care, docetaxel, as second-line (2L) treatment in advanced non-squamous (NSQ) NSCLC patients in Spain. Methods: An economic model with 3 health-states: progression free (PF), progressive disease (PD) and death was used to simulate, for a lifetime horizon, the total costs (e,2016) and clinical evolution of 1,000 NSQ NSCLC patients, treated with nivolumab or docetaxel. PF survival (PFS) and overall survival (OS) Kaplan-Meier curves, derived from CheckMate 057 trial, were used for monthly modelling of patient survival. Adverse event (AE) frequency and quality of life (utilities) were derived from CheckMate 057. PD implied the administration of one subsequent treatment (3L, defined by local oncologists). Costs relevant for the National Health System were included: acquisition drug costs (for 2L and subsequent treatments) using public list prices (confidential reimbursed price was used in an alternative analysis), administration, Grade 3-4 AE management, monitoring, and follow-up disease management at PF, PD and “end of life” care. Dosages for both therapies were derived from Summary of Product's Characteristics. Costs and outcomes were discounted (3% annually). Unitary costs were obtained from a national costs database. Resources consumption for AE, disease management and pattern for 3L were defined by local oncologists. Sensitivity analyses (SA) were performed to verify the model robustness. Results: Nivolumab was more effective than docetaxel, yielding 0.96 LYG and 0.81 additional QALY per patient. Total cost was higher with nivolumab (increment of e31,656), mainly driven by 2L drug and follow-up cost. Incremental ratios were e41,431/LYG and e45,738/QALY at public list prices (33,047e/QALY at reimbursed prices). In the probabilistic SA 92.5% of iterations resulted