OBJECTIVES

The objective of this study was to assess the cost-effectiveness of PD-1 and PD-L1 agents, nivolumab, pembrolizumab, and atezolizumab, compared with docetaxel as second-line treatment in non-small cell lung cancer (NSCLC) patients who were previously treated with platinum-containing chemotherapy from the United States societal perspective.

METHODS

: A Markov model with three health states was developed using the literature-based data for transition probabilities, costs, and health utilities. The model estimated incremental cost-effectiveness ratio (ICER) and net monetary benefits (NMB) for each of three study drugs compared with docetaxel. One-way and probabilistic sensitivity analyses concerning key parameters were conducted to test the robustness of the results.

RESULTS

: The base-case ICERs were $253,635/QALY for nivolumab, $358,835/QALY for pembrolizumab, and $208,898/QALY for atezolizumab. Docetaxel and atezolizumab had extended dominance over nivolumab and pembrolizumab. One-way sensitivity analysis indicated that the results were most sensitive to the length of median overall survival respective to each drug and health utility in progressive disease state. Probabilistic sensitivity analyses revealed that nivolumab, pembrolizumab, and atezolizumab would have 50% probability of being cost-effective at willingness-to-pay (WTP) threshold of $240,000, $360,000, and $185,000 per QALY or greater, respectively.

CONCLUSIONS

: At WTP threshold of $150,000/QALY, none of the three drugs are likely to be considered cost-effective. Because of the extended dominance by docetaxel and atezolizumab, nivolumab and pembrolizumab would not be considered cost-effective at any WTP threshold.