Background A total of 1.6 million new cases of lung cancer are diagnosed each year, with 1.4 million deaths annually. Nivolumab (NIV), a programmed death 1 (PD-1) immune checkpoint inhibitor antibody, has demonstrated improved survival in previously treated advanced NSCLC.

Purpose This analysis aimed to evaluate the incremental cost effectiveness ratio (ICER) for NIV compared with pemetrexed (PMX) for previously treated advanced NSCLC in our hospital and appraise the findings of the manufacturer submitted indirect treatment comparison (ITC) of the relative efficacy of nivolumab versus pemetrexed in advanced non-squamous cell NSCLC patients receiving secondline or higher-line therapy.

Material and methods A retrospective observational study was carried out to estimate our population progression free survival (PFS), measured by the response evaluation criteria in solid tumours (RECIST). The study lasted 15 months (July 2015–September 2016) and included all 0–1 ECOG performance status and patients in the Expanded Access Programme for NIV. Total drug costs were calculated from the ex-manufacturer; administration, indirect or social costs were not considered. The ICER was obtained.

Results Our sample comprised 23 patients, 12 treated with the NIV (group A) and 11 with the PMX (group B) for previously treated advanced NSCLC. Group A: median age was 74 years (range 55–80), median dose was 200 mg and median PFS was 7 months (range 1–13). Median number of cycles was 12 (2–29) with a median cost of €32.160 per patient. Group B: median age was 70 years (range 51–79), median dose was 700 mg and median PFS was 3 months (range 1–14). Median number of cycles was 3 (1–7) with a median cost of €5.762 per patient. NIV compared with PMX resulted in an ICER of €6.600/PFS month gained.

Conclusion Treatment with NIV represents an important advance in previously treated advanced NSCLC, is more effective than PMX but its ICER is high from the payer’s perspective, with a significant impact on spending, according to the manufacturer submitted ITC. Evaluation of the economic impact of these agents on the health system is necessary to guarantee sustainable access to new medicines.

No conflict of interest