Cost-Effectiveness of Nivolumab As an Adjuvant Treatment of Muscle-Invasive Urothelial Carcinoma at High Risk of Recurrence in Switzerland

OBJECTIVES: To assess the cost-effectiveness of nivolumab versus surveillance in Switzerland for the adjuvant treatment of patients with muscle-invasive urothelial carcinoma (UC) at high risk of recurrence who have undergone radical resection.

METHODS: A three-state Markov model (disease-free, recurrent, death) was built and run for a lifetime from a healthcare payer perspective. Outcomes of interest were life-years (LYs), quality-adjusted LYs (QALYs), and incremental cost-utility ratios (ICURs). Patient characteristics, efficacy (disease-free survival), safety (adverse event frequencies), and EQ-5D-5L health state utilities (mapped using the EQ-5D-3L from France in alignment with Matter-Walstra et al. [2014] guidance) were derived from the CheckMate 274 study. Outcomes associated with recurrent disease were modelled using survival data from metastatic UC literature. An annual discount rate of 3.0% was applied to costs and health outcomes. Deterministic, probabilistic sensitivity analyses, and scenario analyses tested the stability of the results.

RESULTS: Nivolumab led to increased total LYs and QALYs and to higher costs (8.73, 7.02, and CHF 127,005, respectively) versus surveillance (5.77, 4.59, and CHF 75,661, respectively), resulting in an ICUR of CHF 21,158/QALY gained. All tested scenarios and varied inputs in the deterministic sensitivity analyses resulted in < 10% and < 32% change from the base-case ICUR, respectively. Probabilistic sensitivity analyses resulted in an average ICUR of CHF 22,334/QALY gained, with nivolumab having almost 100% probability of being cost-effective at a hypothetical willingness-to-pay threshold of CHF 100,000/QALY gained.

CONCLUSIONS: Nivolumab is estimated to be life-extending and cost-effective adjuvant treatment for muscle-invasive UC in Switzerland.