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PD-L1 test-based strategy with Nivolumab as the second-line treatment in advanced NSCLC: A cost-effectiveness analysis in China


Liu, Q and Luo, X and Zhou, Z and Peng, L and Yi, L and Wan, X and Tan, C and Zeng, X, PD-L1 test-based strategy with Nivolumab as the second-line treatment in advanced NSCLC: A cost-effectiveness analysis in China, Frontiers in Oncology, 11 pp. 1-11. ISSN 2234-943X (2021) [Refereed Article]

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Copyright Statement

Copyright 2021 Liu, Luo, Zhou, Peng, Yi, Wan, Tan and Zeng. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) License ( The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

DOI: doi:10.3389/fonc.2021.745493


Objective: Our previous economic assessment found that nivolumab was not cost-effective for Chinese patients with advanced non-small cell lung cancer (NSCLC) and without EGFR mutations or ALK translocations, when compared with the standard second-line drug docetaxel. However, a greater survival benefit with nivolumab was observed for patients with 1% or greater tumor programmed death ligand 1 (PD-L1) expression. In view of this, we designed the present analysis to explore whether it is cost-effective to use the PD-L1 test to guide second-line nivolumab treatment in China.

Material and Methods: A Markov model was established to project the lifetime costs and quality-adjusted life-years (QALYs) of three second-line treatment strategies: nivolumab and docetaxel (strategies without a PD-L1 test) and PD-L1 test-based strategy. Deterministic and probabilistic sensitivity analyses were performed to examine the robustness of our results. Additional price reduction and willingness-to-pay (WTP) threshold scenario analyses were performed to explore the impact of economic and health policies with Chinese characteristics on our results.

Results: The PD-L1 test-based strategy costs approximately CNY 194,607 (USD 28,210) or more and yielded an additional 0.27 QALYs compared to the docetaxel strategy without a PD-L1 test, equating an incremental cost-effectiveness ratio (ICER) of CNY 731,089 (USD 105,978)/QALY. Deterministic sensitivity analyses showed that the price of nivolumab was the strongest source of variation in the ICERs. Probability sensitivity analysis showed that the probability for the PD-L1 test-based strategy being cost-effective increases with the increase of WTP thresholds.

Conclusion: From the perspective of the Chinese healthcare system, using a PD-L1 test to guide second-line nivolumab treatment was not cost-effective. The National Healthcare Security Administration negotiation on the price reduction of nivolumab was found to be the most effective action to improve its cost-effectiveness in China.

Item Details

Item Type:Refereed Article
Keywords:cost-effectiveness, NSCLC, nivolumab, PD-L1 test, China
Research Division:Economics
Research Group:Applied economics
Research Field:Health economics
Objective Division:Health
Objective Group:Clinical health
Objective Field:Efficacy of medications
UTAS Author:Zhou, Z (Dr Zhen Zhou)
ID Code:148333
Year Published:2021
Deposited By:Menzies Institute for Medical Research
Deposited On:2021-12-22
Last Modified:2022-01-17
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