Compared with docetaxel, nivolumab is not a cost-effective treatment option for nonsquamous non-small cell lung cancer unless its price is reduced or it is used after programmed death ligand 1 (PD-L1) testing, according to a recent study.
Past studies have demonstrated that nivolumab is not a cost-effective treatment option for patients with squamous NSCLC, but less data is available about whether the same can be said for its use in patients with nonsquamous disease. Therefore, Swiss researchers conducted a study comparing the incremental cost-effectiveness ratio (ICER) of nivolumab versus docetaxel and how PD-L1 positivity affected patient selection. Clinical trial data was used to construct a model of ICERs.
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In a statistical model created using clinical trial data, treating all patients with nivolumab compared with all with docetaxel resulted in an ICER of CHF177,478 per quality adjusted life year. However, when the drugs were only used in patients that were PD-L1 positive, the ICER was CHF133,267 per QALY and CHF124,891 per QALY for nivolumab and docetaxel, respectively, both above the willingness-to-pay threshold of CHF100,000. However, researchers also found that dose reductions of 1 mg/kg and lowering the price of nivolumab by at least 45% reduced ICERs below the CHF100,000 willingness-to-pay threshold. Health state utilities were the strongest influencers of cost-effectiveness.
Thus, researchers concluded that, compared with docetaxel, nivolumab was not cost-effective for the treatment of nonsquamous NSCLC at its current price. However, reductions in price and treating patient who are positive for PD-L1 could help to improve cost effectiveness.
“The easiest way to improve cost-effectiveness is to lower drug prices,” authors of the study added in a press release. “It will be interesting to see if NICE reaches similar conclusions for non-squamous NSCLC and if they can negotiate a lower price for NIV in the UK. Although our results are not directly generalizable to other countries, the Swiss system is comparable to the US system and to many European countries in terms of patient care and cost.”
They also said that while PD-L1 testing added to the total costs of nivolumab testing, it resulted in better effectiveness than when all patients were treated with nivolumab. Thus, PD-L1 testing should be considered in patients with non-squamous NSCLC.
