Cost-Effectiveness of Nivolumab Plus Ipilimumab versus Chemotherapy for Previously Untreated Metastatic NSCLC Using Mixture-Cure Survival Analysis Based on CheckMate 227 5-Year Data

Alison D. Griffiths, Robert O. Young (), Yong Yuan, Mohammad A. Chaudhary, Adam Lee, Jason Gordon and Philip McEwan
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Alison D. Griffiths: Health Economics and Outcomes Research Ltd
Robert O. Young: Health Economics and Outcomes Research Ltd
Yong Yuan: Bristol-Myers Squibb
Mohammad A. Chaudhary: Bristol-Myers Squibb
Adam Lee: Bristol-Myers Squibb
Jason Gordon: Health Economics and Outcomes Research Ltd
Philip McEwan: Health Economics and Outcomes Research Ltd

PharmacoEconomics - Open, 2025, vol. 9, issue 2, No 6, 247-257

Abstract: Abstract Objectives This study assessed the cost-effectiveness of nivolumab plus ipilimumab (NIVO+IPI) versus platinum-doublet chemotherapy (chemo) in untreated metastatic non-small cell lung cancer (NSCLC) using mixture-cure modelling, an approach used to analyse immuno-oncology treatments due to their underlying methods depicting delayed but durable response in some patients. Methods A mixture-cure economic model was developed from a US third-party payer perspective to assess the lifetime costs and benefits of NIVO+IPI versus chemo using data from Part 1 of the phase III CheckMate 227 trial with 5 years of follow-up. The model consisted of four health states: progression-free without long-term response (non-LTR), progression-free with long-term response (LTR), post-progression, and death. The primary outcomes were the incremental cost per life-year (LY) and quality-adjusted life-year (QALY) gained for NIVO+IPI versus chemo over a patient’s lifetime time horizon. Model uncertainty was evaluated using one-way sensitivity analyses and probabilistic sensitivity analysis. Results NIVO+IPI treatment showed a significant improvement in overall survival versus chemo; mean gain 1.69 LYs and 1.42 QALYs. The majority of the 4.04 LYs accrued by NIVO+IPI were in the LTR state (2.27 years). The incremental cost of NIVO+IPI versus chemo was US$125,321, resulting in an incremental cost/QALY gained of US$88,219. Conclusions This study suggests NIVO+IPI may be a cost-effective first-line treatment when compared with chemo in a US setting given a threshold of US$150,000 per QALY. The cost-effectiveness analysis used a mixture-cure approach, which may offer a more appropriate modelling method in immuno-oncology given LTR, by more accurately capturing the potential treatment benefit.

Date: 2025
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DOI: 10.1007/s41669-024-00545-z

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