Economic Evaluation of Nanoparticle Albumin-Bound paclitaxel for Previously Treated Advanced NSCLC in Japan

OBJECTIVES: Although docetaxel is still used as a standard treatment for patients with NSCLC, a recent clinical trial showed that nanoparticle albumin-bound (nab-) paclitaxel was found to be non-inferior to docetaxel. This study aimed to assess the cost-effectiveness of nab-paclitaxel compared with docetaxel from the Japanese payer’s perspective.

METHODS: A partitioned survival analysis model was developed to predict costs and quality-adjusted life years (QALY) in both groups. Data on overall survival and progression-free survival were obtained from the J-AEXL study. Drug costs were estimated based on the drug prices and standard regimen. Other cost parameters were also estimated from JMDC claims database. Utility weights were derived from publicly available sources outside of Japan. Incremental cost-effectiveness ratio (ICER) of nab-paclitaxel compared to docetaxel was estimated. Finally, sensitivity analysis was performed to assess parameter uncertainty.

RESULTS: The incremental cost was estimated to be JPY 4,893,746, the incremental effect was 0.249 QALY, and the ICER was JPY19,694,424/QALY in nab-paclitaxel group compared to docetaxel. Deterministic sensitivity analysis showed that the parameter with the greatest impact on ICER was utility weight of progression-free state in nab-paclitaxel group, and the range of variation in ICER was JPY12,518,994 to JPY115,741,337/QALY. Probabilistic sensitivity analysis resulted in probability of 34.1% that nab-paclitaxel would be cost-effective when the ICER was at the threshold of 15 million/QALY.

CONCLUSIONS: Applying the willingness to pay threshold of JPY15 million/QALY, nab-paclitaxel was not cost-effective. Further research is required on utilities of Japanese patients with NSCLC.