OBJECTIVES:  To analyse the cost-effectiveness of nivolumab versus docetaxel as second-line (2L) treatment in advanced squamous NSCLC patients, in Spain. METHODS: A partitioned survival model with three health states (progression-free, progressed disease [PD], and death) was developed to estimate live years gained (LYG), quality adjusted life years (QALY) and costs (€,2016) over a lifetime. Costs and outcomes were discounted at 3%. Transitions per weekly cycles were estimated using parametric functions fitted to progression-free and overall survival data from the CheckMate017 trial. The transition to PD included the administration of subsequent therapies. Health state-specific utilities (applying Spanish tariffs to EuroQoL scores) and Grade 3-4 adverse events (AEs) with an incidence ≥5% were obtained from CheckMate017. Costs were calculated from a National Health System (NHS) perspective and included: drug acquisition for 2L and subsequent therapies (ex-factory public prices with mandatory deduction, which are higher than those reimbursed by the NHS), administration, management of AEs associated with nivolumab and docetaxel and disease management whilst in PF and PD. Oncologists provided health care resource use for AEs, disease management, and subsequent therapy pattern. Dosages were derived from the respective Summary of Products Characteristics. Deterministic and probabilistic sensitivity analyses (SA) were performed. RESULTS: Nivolumab yielded 1.11 incremental LYG/patient (2.02 vs. 0.91) and 0.81 incremental QALY/patient (1.38 vs. 0.57) vs. docetaxel. Total incremental cost was €40,559 for nivolumab vs. docetaxel and the incremental cost-effectiveness ratios were €36,792/LYG and €49,867/QALY gained. The ratios were lower when the NHS-reimbursed drug price of nivolumab was used. The most influential parameter was the OS hazard ratio. In probabilistic SA, 74% of simulations yielded ratios below €60,000/QALY gained. CONCLUSIONS: Considering the willingness-to-pay threshold applied by NICE for oncologic drugs fulfilling end-of-life criteria (<€65,000/QALY, applicable to nivolumab), nivolumab could be regarded as a cost-effective therapy (using public prices) for 2L squamous NSCLC.