OBJECTIVES:

uMPM is associated with poor prognosis and high burden of disease with a high need for new therapeutic options. CheckMate-743 (NCT02899299) has demonstrated survival and quality of life benefits for nivolumab plus ipilimumab vs. pemetrexed plus cisplatin/carboplatin (chemotherapy) as first-line (1L) treatment in uMPM. Nivolumab+ipilimumab is the new standard of care for 1L treatment in the recent ESMO and Dutch guidelines. To assess the long-term survival and economic benefits, we conducted a cost-effectiveness analysis of nivolumab+ipilimumab vs. chemotherapy for 1L uMPM in the Netherlands for the overall population.

METHODS:

A partitioned survival model was developed. Survival data were sourced from CheckMate-743 (Database lock April 3, 2020, minimum follow-up 22.1 months) and extrapolated to a 20-year time horizon while considering the appropriateness of statistical fit and long-term follow-up from the MAPS clinical trial and SEER registry data. Extrapolations were also assessed against longer follow-up data from the CheckMate-743 trial. Utility estimates were derived from the trial, and resource use was based on the literature and clinical experts input reflecting a societal perspective. All drug costs were based on the list prices.

RESULTS:

The mean quality-adjusted life years (QALYs) with nivolumab+ipilimumab and chemotherapy were 2.00 and 1.33 respectively, yielding an incremental benefit of 0.68 QALYs. The total costs with nivolumab+ipilimumab and chemotherapy were €128,058 and €48,739. The incremental cost-utility ratio (ICUR) was €117,242/QALY gained. Longer-term follow-up from CheckMate-743 confirmed the robustness of the survival extrapolations.

CONCLUSIONS:

This study provides robust modeling evidence that confirms nivolumab+ipilimumab as an effective intervention for the overall population. The estimated ICUR is above the applicable cost-effectiveness threshold (€80,000/QALY gained). Yet these results should be interpreted with caution in the absence of details on confidential prices of nivolumab+ipilimumab for which national financial agreements are now in place, leading to improved cost-effectiveness results.