OBJECTIVES: To evaluate the cost-effectiveness of nivolumab plus ipilimumab (NIVO+IPI) versus platinum-doublet chemotherapy (PDC) and other immunotherapies used as first-line treatment for stage IV or recurrent non-small cell lung cancer (NSCLC) in the United States (US) from a third-party payer perspective.

METHODS: A partitioned-survival model was developed using efficacy, safety, and utility data from the Phase III CheckMate 227 Part 1 trial with 49.4-month minimum follow-up for overall survival (OS). OS and progression-free survival were extrapolated (20-year time horizon) using parametric models for NIVO+IPI and PDC treatments and using Bayesian fractional polynomial network meta-analysis (FPNMA) for atezolizumab plus bevacizumab plus chemotherapy (ATEZO+BEVA+PLAT+TAX), and for pembrolizumab, used as monotherapy (PEMBRO MONO) or in combination with chemotherapies (PEMBRO+PLAT+PEMX and PEMBRO+PLAT+TAX). All costs were US-specific (2023 dollars) and an annual discount rate of 3% was applied to both costs and outcomes. Incremental cost-effectiveness ratios (ICERs) were calculated as cost per Life-Year (LY) and cost per Quality-Adjusted Life-Year (QALY) gained. Probabilistic sensitivity analyses (PSA) were conducted to assess the robustness of the findings.

RESULTS: NIVO+IPI (LYs: 3.40, QALYs: 2.77, total cost: $269,122) was associated with higher LYs/QALYs and lower costs (i.e., dominant) versus PEMBRO+PLAT+PEMX (LYs: 3.01, QALYs: 2.34, total cost: $418,595) and ATEZO+BEVA+PLAT+TAX (LYs: 2.51, QALYs: 1.96, total cost: $368,679); with higher LYs/QALYs and costs versus PEMBRO+PLAT+TAX (LYs: 2.97, QALYs: 2.31, total cost: $268,678, ICER: $957) and PDC (LYs: 2.09, QALYs: 1.63, total cost: $127,007, ICER: $124,306); and with lower LYs/QALYs and higher costs (i.e., dominated) versus PEMBRO MONO in patients with PD-L1>=50% (LYs: 3.78, QALYs: 3.10, total cost: $237,313). PSA results were consistent with the base-case findings.

CONCLUSIONS: This cost-effectiveness analysis was the first to incorporate published FPNMA results comparing NIVO+IPI against other immunotherapies used as first-line treatment of advanced NSCLC in the US and found NIVO+IPI to be a cost-effective option against most of the comparators.