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Poster display session

4463 - Efficiency of nivolumab in the treatment of second-line advanced non-squamous non-small cell lung cancer (NSCLC) in Spain


09 Sep 2017


Poster display session


Paloma González


Annals of Oncology (2017) 28 (suppl_5): v460-v496. 10.1093/annonc/mdx380


P. González1, N. Ortega-Joaquín2, M. Provencio Pulla3, C. Garrido1, M. Echave2

Author affiliations

  • 1 Medical Department, Bristol Myers Squibb, 28050 - Madrid/ES
  • 2 Pharmacoeconomics, PORIB (Pharmacoeconomics and Outcomes Research Iberia), 28224 - Pozuelo de Alarcón, Madrid/ES
  • 3 Servicio De Oncología Médica, Hospital Universitario Puerta de Hierro, 28222 - Majadahonda, Madrid/ES


Abstract 4463


The aim was to estimate the cost per life year gained (LYG) and quality-adjusted life year (QALY) of nivolumab compared to the standard of care, docetaxel, as second-line (2L) treatment in advanced non-squamous (NSQ) NSCLC patients in Spain.


An economic model with 3 health-states: progression free (PF), progressive disease (PD) and death was used to simulate, for a lifetime horizon, the total costs (€,2016) and clinical evolution of 1,000 NSQ NSCLC patients, treated with nivolumab or docetaxel. PF survival (PFS) and overall survival (OS) Kaplan-Meier curves, derived from CheckMate 057 trial, were used for monthly modelling of patient survival. Adverse event (AE) frequency and quality of life (utilities) were derived from CheckMate 057. PD implied the administration of one subsequent treatment (3L, defined by local oncologists). Costs relevant for the National Health System were included: acquisition drug costs (for 2L and subsequent treatments) using public list prices (confidential reimbursed price was used in an alternative analysis), administration, Grade 3-4 AE management, monitoring, and follow-up disease management at PF, PD and “end of life” care. Dosages for both therapies were derived from Summary of Product´s Characteristics. Costs and outcomes were discounted (3% annually). Unitary costs were obtained from a national costs database. Resources consumption for AE, disease management and pattern for 3L were defined by local oncologists. Sensitivity analyses (SA) were performed to verify the model robustness.


Nivolumab was more effective than docetaxel, yielding 0.96 LYG and 0.81 additional QALY per patient. Total cost was higher with nivolumab (increment of €31,656), mainly driven by 2L drug and follow-up cost. Incremental ratios were €41,431/LYG and €45,738/QALY at public list prices (33,047€/QALY at reimbursed prices). In the probabilistic SA 92.5% of iterations resulted


Considering a willingness-to pay threshold of €30,000-€45,000/QALY gained, nivolumab versus docetaxel could be considered a cost-effective option for 2L treatment in Spanish patients with NSQ NSCLC.

Clinical trial identification

Legal entity responsible for the study

Bristol Myers Squibb


Britol Myers Squibb


P. González, C. Garrido: Employee of BMS. N. Ortega-Joaquín: Employee of PORIB (consultant company) has received financial support from BMS regarding the development os the present project. M. Provencio Pulla: Financial support from BMS regarding the development os the present project. M. Echave: Employee of PORIB (consultant company) has received financial support from BMS regarding the development os the present project.

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