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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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 Type:||Refereed Article|
|Keywords:||cost-effectiveness, NSCLC, nivolumab, PD-L1 test, China|
|Research Group:||Applied economics|
|Research Field:||Health economics|
|Objective Group:||Clinical health|
|Objective Field:||Efficacy of medications|
|UTAS Author:||Zhou, Z (Dr Zhen Zhou)|
|Deposited By:||Menzies Institute for Medical Research|
|Downloads:||8 View Download Statistics|
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