Ανάλυση κόστους - αποτελεσματικότητας του Nivolumab έναντι του Docetaxel σε προχωρημένο πλακώδη μη μικροκυτταρικό καρκίνο του πνεύμονα
Cost - effectiveness analysis of Nivolumab versus Docetaxel in the treatment of advanced squamous non-small cell lung cancer
KeywordsΠλακώδης μη μικροκυτταρικός καρκίνος του πνεύμονα ; Οικονομική αξιολόγηση ; Markov μοντέλο ; QALYs ; ICER ; Nivolumab ; Docetaxel ; Squamous non-small-cell lung cancer ; Economic evaluation ; Markov model
Background: Lung cancer is the most common type of cancer in the world and it is associated with significant morbidity and mortality. Nivolumab, according to the Clinical Study CheckMate-017, has demonstrated statistically significant improvement in progression-free survival (PFS) and overall survival (OS) in patients with advanced NSCLC following previous treatment with chemotherapy. Nivolumab (NIV) was recently approved in several countries including Greece as a second-line therapy for patients with advanced NSCLC. However the cost-effectiveness of Nivolumab compared to Docetaxel (DOC) for the treatment of squamous NSCLC has not been evaluated in Greece yet. Objective: The objective of this analysis is to assess the cost-effectiveness of treating advanced NSCLC with Nivolumab compared to the standard of care Docetaxel as a second line therapy in patients with secondary squamous non-small cell lung cancer in Greece. Method: The analysis was performed using a Markov model. The data that was used to populate the model was derived from the international and Greek published literature. To assess clinical effectiveness, the analysis used the results of the clinical trial CheckMate-017. The viewpoint of the analysis was that of the Greek National Health System. The Markov model includes three health states, progression free disease -PF, disease progression- PD and Death. The model followed a hypothetical group of patients aged 63 years from the beginning of the treatment to death in 1 month cycles. Disease Progression and time to progression were evaluated by determining the transition probabilities to each state as based on the survival probabilities drawn from the clinical study CheckMate-017 for PFS and OS. Cost and clinical effectiveness were calculated by combining the use of medical resources with their unit costs and the quality of life attributed to each of the three health model states. The measures of clinical effectiveness included in the model were survival and survival adjusted for quality of life (life years gained, LYs, and quality-adjusted life years gained, QALYs). In an attempt to handle the uncertainty surrounding the model parameters, one way sensitivity analysis was performed. Results: Compared to DOC, Nivolumab was found to have higher cost per patient and both increased survival in terms of LYs and increased survival adjusted for quality of life (QALYs). The incremental cost (ICER) per life year gained (LYG) was € 27,552.14 and per QALY gained was found to be € 42,515.31 over the lifetime of the patients. Based on the sensitivity analysis these results were found to be sensitive to the values of the probabilities of transition to the advanced stage (PD) of the disease which were used in the model. Conclusions: Based on the results of this analysis, Nivolumab compared to DOC could be considered a cost-effective option as a second-line treatment for patients with advanced squamous non-small cell lung cancer in the current Greek health care setting.