The Cost-Effectiveness of Immunotherapy in Treating Non-Small Cell Lung Cancer: A Review of Previous Analyses and Graphical Model

• Main Author: Anderson, Danyon
• Format: Others
• Published: Scholarship @ Claremont 2018
• Subjects: cancer; immunotherapy; lung; non-small cell; cost; effectiveness; Other Medicine and Health Sciences
• Online Access: http://scholarship.claremont.edu/cmc_theses/1814; http://scholarship.claremont.edu/cgi/viewcontent.cgi?article=2801&context=cmc_theses

Immunotherapy is a potent new treatment for non-small cell lung cancer. However, immunotherapy is much more expensive than many treatment alternatives. Previous cost-effectiveness analyses determined that nivolumab would be cost effective if it elicits a response rate greater than 20% (Sullivan et al., 2016), is given to all non-squamous and all PD-L1 positive squamous stage IV non-small cell lung cancer patients (Aguiar et al., 2016), or is 33% cheaper for PD-L1 positive patients or 45% cheaper for all patients (Matter-Walstra et al., 2017). This thesis analyzes these three studies and accounts for the effect that many responders survive much longer than those who respond to other treatments by modeling overall survival for patients on nivolumab with two regressions. These regressions estimate, that after 150 months, the value (in terms of life-years saved) of nivolumab is about four times greater than that of docetaxel. Depending on pricing strategy, nivolumab was found to cost either $1,000 less or $16,000 more per month of survival than docetaxel. These estimates differ considerably due to imprecision in price estimates. Because of this high degree of uncertainty, it is impossible to say whether or not nivolumab is cost effective. Due to the considerably longer average survival which results from nivolumab treatment and the ambiguous cost-effectiveness results, immunotherapy should be treated as a possibly cost-effective treatment. Further cost-effectiveness analyses will be necessary once future costs of immunotherapy can be better estimated.