Cost-Effectiveness of Perioperative Nivolumab for Stage III Non–Small-Cell Lung Cancer: A Perspective From The United States

Purpose

The NADIM II trial demonstrated that combining perioperative nivolumab, an immune checkpoint inhibitor, with intensified chemotherapy significantly enhanced pathological complete response rates and overall survival in patients with surgically resectable stage III non–small-cell lung cancer (NSCLC) compared to those receiving chemotherapy alone. However, concerns persist regarding the substantial cost of immunotherapy. Our study aims to evaluate the cost-effectiveness of neoadjuvant treatment combining nivolumab with chemotherapy versus standard neoadjuvant chemotherapy alone in resectable stage III NSCLC patients within the U.S. healthcare system.

Methods

Using data from the NADIM II trial, we developed a Markov model with 3 distinct health states to accurately simulate the overall health outcomes of NSCLC patients following different treatment strategies. This model not only computed essential economic metrics such as life years (LY), quality-adjusted life years (QALY), incremental cost-effectiveness ratio (ICER), and total costs but also ensured robustness through sensitivity and subgroup analyses.

Findings

The group receiving nivolumab plus chemotherapy achieved 7.89 QALYs (9.75 LYs) at a total cost of $428,701.08, whereas the chemotherapy-alone group attained 6.80 QALYs (8.53 LYs) with total costs amounting to $318,550.20. This resulted in an incremental cost of $110,150.88. Considering a willingness-to-pay (WTP) threshold of $150,000/QALY in the United States, the ICER was determined to be $100,879.21/QALY ($90,193.76/LY).

Implications

Based on these findings, in the United States, the perioperative use of nivolumab combined with chemotherapy appears to be cost-effective compared to chemotherapy alone for patients with stage III NSCLC, given a WTP threshold of $150,000/QALY.