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 Peru from a third-party payer perspective.

METHODS: The analysis was based on a previously published partitioned-survival model 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 in combination with chemotherapies (PEMBRO+PLAT+PEMX and PEMBRO+PLAT+TAX). Costs were expressed in 2024 Peruvian Sols (PEN) 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: 3.17, QALYs: 2.57, total cost: PEN 359,065) was associated with higher LYs/QALYs and lower costs (i.e., dominant) versus PEMBRO+PLAT+PEMX (LYs: 3.01, QALYs: 2.26, total cost: PEN 500,610), PEMBRO+PLAT+TAX (LYs: 2.92, QALYs: 2.18, total cost: PEN 476,063) and ATEZO+BEVA+PLAT+TAX (LYs: 2.50, QALYs: 1.87, total cost: PEN 538,480); and with higher LYs/QALYs and costs versus PDC (LYs: 2.04, QALYs: 1.54, total cost: PEN 86,759, ICER: PEN 264,116/QALY gained. 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 options for first-line treatment of advanced NSCLC in Peru. NIVO+IPI was associated with better health outcomes than comparators and with lower total costs than the other immunotherapy regimens.