COST-EFFECTIVENESS OF FIRST-LINE NIVOLUMAB-BASED THERAPY FOR HER2-NEGATIVE ADVANCED GASTRIC CANCER, GASTROESOPHAGEAL JUNCTION CANCER, AND ESOPHAGEAL ADENOCARCINOMA IN JAPAN
Author(s)
Chanon Nusawat, PharmD., MPH, So Sato, MD., PhD., Yuya Kimura, MD., MPH, PhD., Hideo Yasunaga.
University of Tokyo, Tokyo, Japan.
University of Tokyo, Tokyo, Japan.
OBJECTIVES: Following CheckMate649 updated 5-year survival data and recent price reductions in Japan, this study assessed the cost-effectiveness of first-line nivolumab plus chemotherapy versus chemotherapy alone in patients with HER2-negative advanced gastric, gastroesophageal junction, and esophageal adenocarcinoma. Although global guidelines preferentially recommend this treatment for patients with programmed death-ligand 1 (PD-L1) combined positive score (CPS) ≥5, previous economic evaluations did not demonstrate cost-effectiveness at earlier drug prices
METHODS: A three-state Markov model (progression-free, progressed disease, death) with 3-week cycle and 10-year horizon was developed from the Japanese payer perspective. Transition probabilities were derived from the 5-year follow-up of CheckMate649. Health utilities were sourced from published EQ-5D studies, and costs were obtained from the national fee schedule and Japanese claims database. Analyses were conducted for the overall population and PD-L1 CPS ≥1 and ≥5 subgroups. Outcomes were expressed as incremental cost-effectiveness ratios (ICERs) in USD per quality-adjusted life-year (QALY). Deterministic and probabilistic sensitivity analyses were performed using a willingness-to-pay threshold of $50,000/QALY
RESULTS: Nivolumab plus chemotherapy increased both costs and QALYs compared with chemotherapy alone. In the overall population, the ICER was $97,009/QALY. In contrast, the CPS ≥5 subgroup showed greater incremental benefit (0.68 QALYs) and an ICER of $46,174/QALY, falling below the threshold. Probabilistic sensitivity analysis showed a 58% probability of cost-effectiveness in CPS ≥5 patients, versus approximately 10% in other groups. One-way sensitivity analysis indicated that transition probabilities from progression-free survival to progressed disease and death were key drivers of the ICER in the CPS ≥5 subgroup, while the transition from progression-free survival to death had the greatest impact in the other groups
CONCLUSIONS: Nivolumab plus chemotherapy is cost-effective in Japan for patients with PD-L1 CPS ≥5, but not in the other groups. These findings support biomarker-guided treatment strategies and highlight the importance of pricing in determining value
METHODS: A three-state Markov model (progression-free, progressed disease, death) with 3-week cycle and 10-year horizon was developed from the Japanese payer perspective. Transition probabilities were derived from the 5-year follow-up of CheckMate649. Health utilities were sourced from published EQ-5D studies, and costs were obtained from the national fee schedule and Japanese claims database. Analyses were conducted for the overall population and PD-L1 CPS ≥1 and ≥5 subgroups. Outcomes were expressed as incremental cost-effectiveness ratios (ICERs) in USD per quality-adjusted life-year (QALY). Deterministic and probabilistic sensitivity analyses were performed using a willingness-to-pay threshold of $50,000/QALY
RESULTS: Nivolumab plus chemotherapy increased both costs and QALYs compared with chemotherapy alone. In the overall population, the ICER was $97,009/QALY. In contrast, the CPS ≥5 subgroup showed greater incremental benefit (0.68 QALYs) and an ICER of $46,174/QALY, falling below the threshold. Probabilistic sensitivity analysis showed a 58% probability of cost-effectiveness in CPS ≥5 patients, versus approximately 10% in other groups. One-way sensitivity analysis indicated that transition probabilities from progression-free survival to progressed disease and death were key drivers of the ICER in the CPS ≥5 subgroup, while the transition from progression-free survival to death had the greatest impact in the other groups
CONCLUSIONS: Nivolumab plus chemotherapy is cost-effective in Japan for patients with PD-L1 CPS ≥5, but not in the other groups. These findings support biomarker-guided treatment strategies and highlight the importance of pricing in determining value
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE679
Topic
Economic Evaluation, Health Technology Assessment, Real World Data & Information Systems
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology