Background Nivolumab (NIV) is a monoclonal antibody for patients with pre-treated advanced nonsquamous non–small-cell lung cancer (NSCLC). It is necessary to evaluate the cost effectiveness of NIV versus docetaxel (DOC), taking into consideration the expression of programmed death ligand 1 (PD-L1).

Purpose Cost-effectiveness analysis from the payer’s perspective of NIV versus DOC in patient with nonsquamus NSCLC by expression of PD-L1 test (subgroups:<10% vs.≥10%).

Material and methods Efficacy data were obtained from the CheckMate-057 trial to model the incremental cost-effectiveness ratio (ICER) of NIV versus DOC:

Difference of overall survival (OS) between NIV vs. DOC: PD-L1 expression ≥10%: 0.9 life years gained (LYG) and PDL1 expression <10%: −0.03 LYG.

Drug costs were estimated considering manufacturing costs plus VAT (4%). NIV: mg/m²; DOC: mg/m². An adult patient was considered (weight=70 kg; body surface: 1.7 m²) (total doses per administration: NIV: 210 mg; DOC: 127.5 mg). Total treatment costs were estimated with the median of the number of administrations received (NIV: six administrations; DOC: four administrations). Other costs were not considered.

Time horizon considered: 1 year.

Two different one-way sensitivity analyses were performed to test the robustness of the model.

Scenario 1: Difference in OS variation was considered.

Variations of ±20% OS were performed:

PDL1 expression ≥10%. Interval considered: 0.792 LYG – 1.18 LYG.

PDL1 expression <10%. Interval considered: −0.036 LYG – −0.024 LYG.

Scenario 2: Cost mg variation was considered. Variations of ±25% were performed.

Interval considered: €17.14/mg – €10.28/mg.

Results Treatment total costs were: NIV: €17,274.60 and DOC: 1167.92€.

The ICER observed in the subgroup with PD-L1 expression ≥10% was €16,269.37/LYG. Otherwise, the ICER estimated in patients with PDL1 expression <10% was €536,889.33/LYG.

No relevant differences in ICER were observed after both one-way sensitivity analyses were performed (OS variation and cost mg variation).

Conclusion NIV vs. DOC is cost effective in patients with non-squamous NSCLC with PD-L1 expression ≥10%, although ICER is high.

NIV vs. DOC is not cost effective in patients with non-squamous NSCLC with PD-L1 expression <10%.

Reference and/or Acknowledgements 1. Borghaei H, Paz-Ares L, Horn L, et al. Nivolumab versus docetaxel in advanced nonsquamous non-small-cell lung cancer. N Engl J Med2015;373:1627–39.

No conflict of interest