OBJECTIVES:

Cost-effectiveness analyses are often used by health technology appraisal agencies to inform reimbursement decisions for new therapies. These evaluations, however, are often performed adopting a payer’s perspective that does not include important elements of value that treatments may generate (e.g., increased productivity, reduced caregiving costs, patients’ hope, option value, or insurance value). There is currently limited evidence quantifying condition-specific novel value elements.

METHODS:

To assess the impact of novel value elements on traditional cost-effectiveness analysis, this study estimated the net monetary benefit (NMB) associated with nivolumab plus ipilimumab (N+I) as first-line strategy for patients with metastatic non-small cell lung cancer (mNSCLC) compared with platinum doublet chemotherapy (PDC) in the United Kingdom (UK). Three perspectives were explored: traditional payer, traditional societal, and broad societal. The CheckMate 227 Part 1 pivotal trial informed N+I and PDC clinical efficacy, safety, treatment duration, and utilities. Quantitative measures of patients’ and caregivers’ indirect costs, value of hope, option value, and insurance value were informed by mNSCLC-specific studies identified through a targeted literature review.

RESULTS:

Under a traditional payer perspective, N+I was associated with higher costs and provided more quality-adjusted life-years (QALYs) compared with PDC (£71,154 incremental costs, 1.09 incremental QALYs). At a willingness-to-pay threshold of £50,000/QALY gained, the estimated NMB was -£16,437, indicating that costs exceed benefits. Expanding the traditional payer perspective to a traditional societal perspective led to a slight increase in the incremental costs, whilst further expanding the analysis to a broad societal perspective increased the QALY gain of N+I by 118% (1.09 versus 2.38 QALYs). The NMB estimated adopting a broad societal perspective was +£48,042, indicating that the benefits associated with N+I outweighed its costs.

CONCLUSIONS:

Including novel value elements in the cost-effectiveness analysis for N+I as first-line mNSCLC strategy was able to capture additional value beyond the traditional payer perspective.