Lung cancer is the leading cause of cancer-related deaths in Australia with NSCLC NSQ accounting for the majority of cases. Current 2nd line treatment for NSCLC NSQ in Australia is limited to either docetaxel or pemetrexed which largely are ineffective and have a low response rate. Nivolumab, an immunotherapy which blocks programmed cell death-1 inhibition of the immune system, has recently demonstrated superior overall survival in 2nd line treatment of NSCLC NSQ patients vs docetaxel in a clinical trial setting.
The aim of this study was to evaluate the cost-effectiveness of nivolumab versus a basket of comparators containing docetaxel and pemetrexed which could be considered standard of care in an Australian setting.
A partitioned survival model with three health states (progression free, progressive disease and death) was developed for this CEA. The model was run for both docetaxel and pemetrexed and an average ICER was calculated.
Clinical trial data was utilised for the docetaxel comparison whereas an indirect comparison was performed in order to inform the pemetrexed component of the evaluation. Australian specific cost in terms of drugs and health resources were applied. Both one/two way and probabilistic sensitivity analyses were performed.
The results of the CEA showed that patients treated with nivolumab saved 1.02 life years (LY) (nivolumab=2.22 vs mixed comparator=1.20). Similarly for quality adjusted life years (QALYs), nivolumab saved 0.80 QALYs when compared to the mixed comparator. This came at an additional cost of US$49.0k which equates ICERs of US$48k/LY and US$60.9k/QALY. The model was most sensitive to comparator price, extrapolation method and discount rate.
This study indicates that nivolumab is a cost-effective alternative to docetaxel and pemetrexed in Australia with the potential of significantly decreasing both mortality and morbidity for patients treated for 2nd line NSCLC NSQ.