Third-Line Nivolumab Cost-Effective Compared to Topotecan for SCLC

A study comparing the cost-effectiveness of nivolumab monotherapy vs commonly prescribed third-line treatment for small cell lung cancer (SCLC) found that nivolumab monotherapy may be the more cost-effective option (J Med Econ. 2021; doi:10.1080/13696998.2021.1974763).

Caitlin Smare, MSc, a HEOR, Parexel International, London, UK, and colleagues constructed a partitioned survival model, from the US payer perspective, that included progression-free survival, progressive disease, and death. No randomized controlled or single-arm trials with separate outcomes for third-line treatment and patients with SCLC were identified.

Topotecan acted as the standard for comparison, as it is frequently prescribed as a third-line treatment for SCLC in the real-world setting. The Flatiron database provided data on the clinical inputs for topotecan, with inclusion and exclusion criteria matched to patients treated with third-line plus nivolumab in CheckMate 032.

A 20-year lifetime horizon was used for the base-case analysis, and an annual 3% discount rate for costs and outcomes was applied.

When compared to IV topotecan, the incremental cost per quality-adjusted life-year (QALY) gained with nivolumab was $153,312. When compared to oral topotecan, the incremental cost per QALY gained with nivolumab was $123,003. Costs for nivolumab were primarily associated with drug acquisition, while most costs for topotecan were related to adverse event treatment.

With nivolumab, the mean overall survival (OS) was 21.69 months, while IV or oral topotecan provided a mean OS of 5.8 months.

The greatest impacts on results included the discount rate for costs, outcomes, and body weight.

“Based on the literature on willingness-to-pay for a QALY in metastatic cancer, nivolumab monotherapy might represent a cost-effective option for 3L + treatment of SCLC compared with IV and oral topotecan,” concluded Ms Smare and colleagues, adding, “Sensitivity analysis using response-based methods yielded further favorable cost-effectiveness estimates.”—Marta Rybczynski