Cost-effectiveness of nivolumab compared with surveillance for adjuvant treatment of muscle-invasive urothelial carcinoma at high risk of recurrence in France.

Abstract

Purpose: To evaluate the cost-effectiveness of nivolumab for adjuvant treatment of adults with muscle-invasive urothelial carcinoma at high risk of recurrence (MIUC-HR) and tumour cell expression PD-L1 ≥ 1% following radical resection from the payer perspective in France.

Methods: A four-state (disease-free, loco-regional recurrence, distant recurrence, death) semi-Markov model was developed to simulate health outcomes and costs in a cohort of patients with MIUC-HR and tumour cell expression PD-L1 ≥ 1% following radical resection. Health state-specific costs and quality of life-adjusted life years (QALYs) were compared between two treatment strategies (nivolumab, surveillance). The time horizon was 15 years. Clinical and utility inputs were modelled from the data obtained in the Phase III trial CheckMate 274 (#NCT02632409). Cost inputs were extracted from French sources (notably the French National Cost Study). Model outputs were life-years and QALYs overall and by health-state, total costs and cost components. The incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR) between the two treatment strategies were calculated.

Results: Life-years were 7.3 for nivolumab and 5.2 for surveillance; QALYs were 4.7 for nivolumab and 3.3 for surveillance. The between-strategy difference in QALYs was essentially accrued in the disease-free state (nivolumab: 4.2, surveillance: 2.6). Total costs were €129,150 for nivolumab and €93,031 for surveillance. The principal cost components were nivolumab acquisition (€ 44,054) and disease management (nivolumab: €29,831; surveillance: €27,233). The estimated ICER was € 17,228/LY gained and the estimated ICUR was €25,806/QALY.

Conclusion: Nivolumab in the adjuvant setting is likely to be cost-effective compared to surveillance in France.