Cost-effectiveness analysis of nivolumab-chemotherapy as first-line therapy for locally advanced/metastatic gastric cancer: a United States payer perspective

Srujitha Marupuru, Daniel Arku, David R. Axon, Lorenzo Villa-Zapata, Mohsen Yaghoubi, Marion K. Slack, Terri Warholak

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Objectives: Nivolumab, an immune checkpoint inhibitor, was approved by the United States (US) Food and Drug administration as a first-line systemic therapy for locally advanced/metastatic gastric cancer patients. The current study aimed to investigate the cost-effectiveness of nivolumab-chemotherapy combination versus chemotherapy alone as a first-line therapy from a US payer perspective. Methods: An economic evaluation was conducted using a partitioned survival model in Microsoft Excel® using data from the CheckMate 649 trial. Three discrete mutually exclusive health states (progression-free, post-progression, and death) were included in the model. The health state occupancy was calculated using the overall survival and progression-free survival curves derived from the CheckMate 649 trial. Cost, resource use, and health utility estimates were estimated from a US payer perspective. Deterministic and probabilistic sensitivity analyses assessed the uncertainty of the model parameters. Results: Nivolumab-chemotherapy provided additional 0.25 life years compared to chemotherapy alone and the quality-adjusted life years (QALYs) were 0.701 and 0.561, respectively, producing a gain of 0.140 QALYs and an incremental cost-effectiveness ratio of $574,072/QALY. Conclusion: From the US payer perspective, at a willingness to pay threshold of $US150,000/QALY, nivolumab-chemotherapy was not found to be cost-effective as a first-line therapy for locally advanced/metastatic gastric cancer.

Original languageEnglish (US)
Pages (from-to)831-841
Number of pages11
JournalExpert Review of Pharmacoeconomics and Outcomes Research
Volume23
Issue number7
DOIs
StatePublished - 2023

Keywords

  • cost-effectiveness
  • gastric cancer
  • metastatic
  • nivolumab
  • trial

ASJC Scopus subject areas

  • Health Policy
  • Pharmacology (medical)

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