Cost-effectiveness of Nivolumab + Platinum Doublet Chemotherapy as Neoadjuvant Treatment for Resectable Non-Small Cell Lung Cancer in England.

[INTRODUCTION] This study aimed to assess the cost-effectiveness of neoadjuvant nivolumab + platinum doublet chemotherapy (PDC) versus relevant comparators in the treatment of patients with non-metastatic (stage IB-IIIA), resectable, non-small cell lung cancer (NSCLC) in England.

[METHODS] A four-state semi-Markov model (event-free survival, locoregional recurrence, distant metastasis, and death states) was developed. Key clinical inputs, including most transition probabilities and all health state utility inputs, were informed by data from the CheckMate-816 trial, which compared neoadjuvant nivolumab + PDC with neoadjuvant PDC. Neoadjuvant PDC, the trial comparator, is not typically used in England, so an indirect treatment comparison (ITC) estimated the relative efficacy of neoadjuvant nivolumab + PDC versus the relevant comparators. Comparators in the ITC and model were aligned with those suggested by the National Institute for Health and Care Excellence (NICE): neoadjuvant chemoradiotherapy, surgery alone, and surgery followed by adjuvant PDC. Costs were informed by standard UK sources. Cost and health outcomes were discounted by 3.5% per year.

[RESULTS] Over a lifetime time horizon, neoadjuvant nivolumab + PDC was dominant versus neoadjuvant chemoradiotherapy and adjuvant PDC, generating 0.26 and 0.7 incremental quality-adjusted life-years (QALYs) while reducing costs by £1674 and £240 per patient, respectively. Neoadjuvant nivolumab + PDC was more costly than surgery alone but was highly cost-effective; its estimated incremental cost-effectiveness ratio (ICER) was £2685 per QALY gained. Sensitivity and scenario analyses confirmed that these results are robust: only one of 10 scenarios tested yielded an ICER above £20,000 (the lower limit of the NICE reimbursement threshold).

[CONCLUSION] Neoadjuvant nivolumab + PDC is a highly cost-effective treatment for nmNSCLC. The findings of this model supported positive reimbursement decisions for neoadjuvant nivolumab + PDC from NICE.