Cost-Effectiveness Analysis of Nivolumab Plus Chemotherapy Vs Chemotherapy in Patients with Advanced Gastric Cancer in Japan
Author(s)
Morimoto K1, Moriwaki K2, Shimozuma K3, Nakayama T4
1Kyoto University, Kyoto, Japan, 2Ritsumeikan University, Kyoto, 26, Japan, 3Ritsumeikan University, Kusatsu, Japan, 4Kyoto Univercity, Kyoto, Japan
Presentation Documents
OBJECTIVES: This study aimed to evaluate the cost-effectiveness of combination therapy of nivolumab plus chemotherapy (FOLFOX or XELOX) (Niv+Chemo) comparing with chemotherapy alone for patients with advanced gastric cancer (AGC) in Japan from the perspective of Japanese payer.
METHOD: A partitioned survival model was developed to predict cost and quality-adjusted life years (QALYs) in a Niv+Chemo arm and a chemotherapy arm. Data on overall and progression-free survival was derived from the CheckMate649 trial. Cost estimates were based on Japanese payer perspective, by using real world data, JMDC claims database. Utilities were derived from previously published study. The incremental cost-effectiveness ratio (ICER) of Niv+Chemo therapy compared with chemotherapy was estimated. A subgroup analysis on the PD-L1 with a combined positive score (CPS) of five or more and one or more was conducted. In addition, deterministic sensitivity analysis was performed to assess the uncertainty in parameter setting.RESULTS: Compared with chemotherapy alone, NIV+Chemo incurred an additional cost of USD139,210 and conferred an additional 0.30 QALY, which results in an ICER of USD458,114/QALY gained. The results of a subgroup analysis showed that the ICER AGC patients for PD-L1 CPS of five or more was USD359,134 and the ICER AGC patients for PD-L1 CPS of one or more was USD424,698. Sensitivity analyses showed a relatively robust result that the ICERs remined higher than a Japanese price adjustment threshold of USD75,000/QALY over the full range of model parameters. The results of scenario analysis showed that the ICERs for a 25% or 50% reduction in the price of nivolumab were estimated to be USD361,410/QALY and USD264,707/QALY, respectively.
CONCLUSION: The combination therapy of nivolumab plus chemotherapy as first-line therapy would not be cost-effective under a willingness-to-pay threshold of USD75,000/QALY.Conference/Value in Health Info
Value in Health, Volume 25, Issue 6, S1 (June 2022)
Code
HTA7
Topic
Economic Evaluation, Study Approaches
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis, Decision Modeling & Simulation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas