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Cost-Effectiveness of First-Line Nivolumab Plus Ipilimumab Combination Therapy in Advanced Non-Small-Cell Lung Cancer in Japan

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Abstract

Background and Objective

In Japan, indications for nivolumab have been expanded to include the combination therapy with ipilimumab in various cancers. This study aimed to evaluate the cost-effectiveness of combination therapy of nivolumab plus ipilimumab (NIV + IPI) for patients with advanced non-small-cell lung cancer (NSCLC), comparing it with platinum-doublet chemotherapy in Japanese settings.

Methods

A partitioned survival model was developed to predict costs and quality-adjusted life-years (QALYs) in a NIV + IPI arm and a chemotherapy arm. Data on overall survival and progression-free survival were derived from the CheckMate 227 trial. Cost estimates were based on a Japanese healthcare system perspective using real-world data from the JMDC claims database. Utilities were derived from published sources outside Japan. The incremental cost-effectiveness ratio (ICER) of NIV + IPI therapy compared with chemotherapy was estimated. A scenario analysis on the level of programmed death-ligand 1 (PD-L1) expression was conducted. In addition, sensitivity analyses were performed to assess the uncertainty in parameter settings.

Results

Compared with chemotherapy, NIV + IPI therapy incurred an additional cost of USD102,623 and conferred an additional 1.007 QALY, which resulted in an ICER of USD101,950/QALY gained. Contrary to prior expectations, the ICER of patients with a PD-L1 expression level ≥ 1% was higher than that of patients with a PD-L1 expression level < 1% (USD145,868/QALY and USD127,737/QALY, respectively). Sensitivity analyses showed a relatively robust result with the ICERs remaining higher than a Japanese price adjustment threshold of USD75,000/QALY with a few exceptions.

Conclusions

The combination of NIV + IPI as first-line therapy would not be cost effective under a willingness-to-pay threshold of USD75,000/QALY from the perspective of the Japanese healthcare system.

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Author information

Authors and Affiliations

  1. Comprehensive Unit for Health Economic Evidence Review and Decision Support (CHEERS), Research Organization of Science and Technology, Ritsumeikan University, #215, Kyoto Research Park Bld. No. 6, 93 Awata-machi, Chudoji, Shimogyo-ku, Kyoto, 600-8815, Japan

    Xiuting Mo, Kensuke Moriwaki, Kosuke Morimoto & Kojiro Shimozuma

  2. Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan

    Kosuke Morimoto

  3. Division of Health Services Research, Department of Biomedical Sciences, College of Life Sciences, Ritsumeikan University, 1-1-1, Noji-higashi, Kusatsu, Shiga, 525-8577, Japan

    Kojiro Shimozuma

  4. Comprehensive Unit for Health Economic Evidence Review and Decision Support (CHEERS), Research Organization of Science and Technology, Ritsumeikan University, #209, Research Park Bid. No.2, 134, Minamimachi, Chudoji, Simogyo-ku, Kyoto, 600-8813, Japan

    Kensuke Moriwaki

Authors
  1. Xiuting Mo
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Corresponding author

Correspondence to Kensuke Moriwaki.

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Funding

This work was supported by Grants-in-Aid for Scientific Research (KAKENHI) Grant number 17H04099 from the Ministry of Education, Culture, Sports, Science and Technology (MEXT)/Japan Society for the Promotion of Science (JSPS).

Conflict of interest

The authors declare that they have no conflicts of interests.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Consent to participate

Not applicable.

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Not applicable.

Data availability

Some of the data generated during and/or analyzed during the current study are not publicly available but are available from the corresponding author on request.

Code availability

The model file created by TreeAge Pro is not publicly available but is available from the corresponding author on request.

Authors’ contributions

Study design: XM and KeM. Data collection: XM, KeM, and KoM. Data analysis: XM, KeM, and KoM. Data interpretation: XM, KeM, KoM, and KS. Manuscript drafting: XM, and KeM. Manuscript content revision: XM and KeM. Final manuscript version approval: XM, KeM, KoM, and KS. KeM takes responsibility for the integrity of the data analysis.

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Mo, X., Moriwaki, K., Morimoto, K. et al. Cost-Effectiveness of First-Line Nivolumab Plus Ipilimumab Combination Therapy in Advanced Non-Small-Cell Lung Cancer in Japan. Clin Drug Investig 42, 599–609 (2022). https://doi.org/10.1007/s40261-022-01168-0

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  • DOI: https://doi.org/10.1007/s40261-022-01168-0

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