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- Title
Cost-effectiveness Analysis of Nivolumab for Treatment of Platinum-Resistant Recurrent or Metastatic Squamous Cell Carcinoma of the Head and Neck.
- Authors
Tringale, Kathryn R.; Carroll, Kate T.; Zakeri, Kaveh; Sacco, Assuntina G.; Barnachea, Linda; Murphy, James D.
- Abstract
<bold>Background: </bold>The CheckMate 141 trial found that nivolumab improved survival for patients with recurrent or metastatic head and neck cancer (HNC). Despite the improved survival, nivolumab is much more expensive than standard therapies. This study assesses the cost-effectiveness of nivolumab for the treatment of HNC.<bold>Methods: </bold>We constructed a Markov model to simulate treatment with nivolumab or standard single-agent therapy for patients with recurrent or metastatic platinum-refractory HNC. Transition probabilities, including disease progression, survival, and probability of toxicity, were derived from clinical trial data, while costs (in 2017 US dollars) and health utilities were estimated from the literature. Incremental cost-effectiveness ratios (ICERs), expressed as dollar per quality-adjusted life-year (QALY), were calculated, with values of less than $100 000/QALY considered cost-effective from a health care payer perspective. We conducted one-way and probabilistic sensitivity analyses to assess model uncertainty.<bold>Results: </bold>Our base case model found that treatment with nivolumab increased overall cost by $117 800 and improved effectiveness by 0.400 QALYs compared with standard therapy, leading to an ICER of $294 400/QALY. The model was most sensitive to the cost of nivolumab, though nivolumab only became cost-effective if the cost per cycle decreased from $13 432 to $3931. The model was not particularly sensitive to assumptions about survival. If one assumed that all patients alive at the end of the CheckMate 141 trial were cured of their disease, nivolumab was still not cost-effective (ICER $244 600/QALY).<bold>Conclusion: </bold>While nivolumab improves overall survival, at its current cost it would not be considered a cost-effective treatment option for patients with HNC.
- Subjects
COST effectiveness; METASTASIS; CANCER relapse; CANCER treatment; SQUAMOUS cell carcinoma; HEAD &; neck cancer treatment; COMPARATIVE studies; DRUG resistance in cancer cells; RESEARCH methodology; MEDICAL care costs; MEDICAL cooperation; PLATINUM compounds; RESEARCH; RESEARCH funding; SURVIVAL analysis (Biometry); EVALUATION research; TREATMENT effectiveness; QUALITY-adjusted life years; DISEASE progression
- Publication
JNCI: Journal of the National Cancer Institute, 2018, Vol 110, Issue 5, p479
- ISSN
0027-8874
- Publication type
journal article
- DOI
10.1093/jnci/djx226