Cost-Effectiveness of Nivolumab Plus Platinum Doublet Chemotherapy as Neoadjuvant Treatment for Resectable NSCLC in Greece
Author(s)
Mack S. Harris, BA1, Fotios Diamantogiannis, MSc2, Pratishtha Khanduri, MSc3, Ariel Sun, MA4, Benjamin White, MS5, Sandra Milev, MSc6, Stefano Lucherini, MSc7.
1Senior Research Associate, Thermo Fisher Scientific, Washington, DC, USA, 2Bristol Myers Squibb, Vrilissia, Greece, 3Thermo Fisher Scientific, Toronto, ON, Canada, 4Thermo Fisher Scientific, San Francisco, CA, USA, 5Thermo Fisher Scientific, Bethesda, MD, USA, 6Thermo Fisher Scientific, Walnut Creek, CA, USA, 7Bristol Myers Squibb, London, United Kingdom.
1Senior Research Associate, Thermo Fisher Scientific, Washington, DC, USA, 2Bristol Myers Squibb, Vrilissia, Greece, 3Thermo Fisher Scientific, Toronto, ON, Canada, 4Thermo Fisher Scientific, San Francisco, CA, USA, 5Thermo Fisher Scientific, Bethesda, MD, USA, 6Thermo Fisher Scientific, Walnut Creek, CA, USA, 7Bristol Myers Squibb, London, United Kingdom.
OBJECTIVES: In June 2023, the European Commission approved nivolumab in combination with platinum-based chemotherapy for the neoadjuvant treatment of resectable non-small cell lung cancer (rNSCLC) at high risk of recurrence in adult patients whose tumours have PD-L1 expression ≥ 1%. This study estimated the cost-effectiveness of neoadjuvant nivolumab+chemotherapy (neoNivo+CT) vs. current treatments for rNSCLC in Greece.
METHODS: A 3-state semi-Markov cohort model was developed based on rNSCLC treatment guidelines, early-stage oncology health technology assessment submissions, and clinician input. Patients entered the model event-free and could progress or die each cycle. Transition probabilities were time-varying and based on standard parametric models using CheckMate-816 data (minimum follow-up: 33 months). Time to progression was specific to each rNSCLC treatment; mortality was rNSCLC treatment agnostic and linked to health state membership. As evidence and clinical opinion suggest, tumor resection can be curative in rNSCLC. 95% of patients who did not progress within 5 years were assumed ‘cured’ and experienced neither progression nor disease-specific mortality. Comparators were neoadjuvant chemotherapy (neoCT), neoadjuvant chemoradiotherapy (neoCRT), adjuvant chemotherapy (adjCT), and surgery only (surg). Indirect treatment comparison informed transition probabilities for neoCRT, adjCT, and surg. All inputs reflected the available sources in April 2024, with drug acquisition costs from 2025. Utilities were derived from EQ-5D data collected in CheckMate-816, adjusted for Greek general population utility. Costs included drug acquisition and administration, adverse event management, medical resource use, and surgical resection; published Greek sources and inputs from Greek experts informed all costs. Post-progression treatment patterns were informed by Greek clinical expert judgement.
RESULTS: Over a lifetime, neoNivo+CT provides 1,145, 0,847, 1,261 and 1,945 more QALYs at an additional cost of €385, €861, €1.050 and €345 vs. neoCT, neoCRT, adjCT, and surg. This yields ICERs/QALY of €336, €1.016, €833 and €177, respectively.
CONCLUSIONS: neoNivo+CT is a cost-effective treatment for rNSCLC in Greece.
METHODS: A 3-state semi-Markov cohort model was developed based on rNSCLC treatment guidelines, early-stage oncology health technology assessment submissions, and clinician input. Patients entered the model event-free and could progress or die each cycle. Transition probabilities were time-varying and based on standard parametric models using CheckMate-816 data (minimum follow-up: 33 months). Time to progression was specific to each rNSCLC treatment; mortality was rNSCLC treatment agnostic and linked to health state membership. As evidence and clinical opinion suggest, tumor resection can be curative in rNSCLC. 95% of patients who did not progress within 5 years were assumed ‘cured’ and experienced neither progression nor disease-specific mortality. Comparators were neoadjuvant chemotherapy (neoCT), neoadjuvant chemoradiotherapy (neoCRT), adjuvant chemotherapy (adjCT), and surgery only (surg). Indirect treatment comparison informed transition probabilities for neoCRT, adjCT, and surg. All inputs reflected the available sources in April 2024, with drug acquisition costs from 2025. Utilities were derived from EQ-5D data collected in CheckMate-816, adjusted for Greek general population utility. Costs included drug acquisition and administration, adverse event management, medical resource use, and surgical resection; published Greek sources and inputs from Greek experts informed all costs. Post-progression treatment patterns were informed by Greek clinical expert judgement.
RESULTS: Over a lifetime, neoNivo+CT provides 1,145, 0,847, 1,261 and 1,945 more QALYs at an additional cost of €385, €861, €1.050 and €345 vs. neoCT, neoCRT, adjCT, and surg. This yields ICERs/QALY of €336, €1.016, €833 and €177, respectively.
CONCLUSIONS: neoNivo+CT is a cost-effective treatment for rNSCLC in Greece.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE264
Topic
Economic Evaluation, Health Technology Assessment
Disease
Biologics & Biosimilars, Oncology, Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)