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Cost-Effectiveness of Nivolumab vs Pembrolizumab for Head and Neck Cancer
For patients with head and neck squamous cell carcinoma, nivolumab was considered cost-effective at a willingness-to-pay (WTP) threshold of $100,000 per quality-adjusted life-year (QALY) for patients weighing less than 72 kg; otherwise, pembrolizumab was preferred (JAMA Netw Open. 2021;[5]:e218065. doi:10.1001/jamanetworkopen.2021.8065).
This network meta-analysis and cost-effectiveness analysis included patients from the CheckMate 141 and KEYNOTE 040 trials. The bayesian network meta-analysis included 856 patients and the cost-effectiveness analysis included 487 patients. A partitioned survival model was developed for the cost-effectiveness analysis. Both analyses were conducted between February and November 2020.
1-way, 2-way, and probabilistic sensitivity analyses were conducted to assess the robustness of the model; subgroup analyses were included. Scenario analyses were conducted to assess the associated of nivolumab dose adjustments with cost-effectiveness.
The primary end points were life-years, QALYs, overall costs, and incremental cost-effectiveness ratios (ICERs).
Findings from the cost-effectiveness analysis show that at a WTP threshold of $100,000 per QALY, compared with pembrolizumab, the probability of nivolumab being cost-effective when administered based on patient weight (3 mg/kg biweekly), was 56%. At a WTP threshold of $150,000 per QALY, the probability of nivolumab being cost-effective was 62%.
At a WTP threshold of $100,000 per QALY, the probability of nivolumab being cost-effective, when administered at a fixed-dose of 240 mg biweekly or 480 mg monthly, was 42% to 45%, respectively. At a WTP threshold of $150,000 per QALY, the probability of nivolumab being cost-effective was 52% to 55%.
Findings from this network meta-analysis and cost-effectiveness analysis suggest considering both WTP threshold and patient body weight when choosing between nivolumab and pembrolizumab for the treatment of patients with platinum-refractory [recurrent or metastatic head and neck squamous cell carcinoma],” concluded study authors.—Janelle Bradley
