OBJECTIVES

To assess the value of nivolumab in the treatment of aNSCLC [squamous (SQ) and non-squamous (NSQ)] after prior platinum-based chemotherapy in adults without EGFR/ALK mutations in China.

METHODS

Partitioned survival models were developed to evaluate lifetime costs and benefits of nivolumab versus docetaxel by histological subtype (SQ and NSQ) from the Chinese healthcare payer’s perspective. The models considered three health states (progression-free; progressive disease; dead) over a 20-year time horizon. Clinical data were derived from pivotal phase-III clinical trials (CheckMate017; CheckMate057; CheckMate078). Parametric functions to extrapolate survival data beyond the trial follow-up period were selected based on best fit. Health state utilities were calculated from EQ-5D-3L data using Chinese tariffs. Health-care resource utilisation and unit costs were obtained from database analysis, systematic literature review, clinician opinion and public information. Sensitivity analyses explored the robustness of results to uncertainty surrounding assumptions and inputs.

RESULTS

Nivolumab was associated with incremental survival (1.235 and 1.330 LYs) and quality of life (0.873 and 0.902 QALYs) benefit at additional cost (¥198,228 and ¥144,248) compared with docetaxel in SQ and NSQ aNSCLC, respectively. Due to a favorable safety profile, AE management costs were lower for nivolumab than docetaxel (¥94 vs. ¥4,928 across histologies), while patients receiving nivolumab incurred lower subsequent treatment costs versus those receiving docetaxel (SQ: ¥23,034 vs. ¥56,474; NSQ: ¥23,020 vs. ¥56,389). Sensitivity analyses determined that drug acquisition costs were a key model driver across histologies.

CONCLUSIONS

It is the first economic evaluation undertaken for nivolumab in the Chinese context. Nivolumab was associated with substantial survival and quality of life benefits at incremental cost compared with docetaxel in aNSCLC. Given a traditional healthcare payer perspective was adopted for the analyses the true economic benefit of nivolumab may be underestimated since not all treatment benefits and costs of relevance to society have been captured.