1287P - Comparing the cost-effectiveness of perioperative immunotherapy strategies in non-small cell lung cancer

Background

Over the course of a year, the FDA approved both adjuvant atezolizumab and neoadjuvant nivolumab plus chemotherapy for resectable non-small cell lung cancer based on positive results from the IMPOWER010 and Checkmate-816 studies respectively. In this analysis, the cost-effectiveness (CE) of these two different treatment methods was evaluated in several clinical scenarios and indirectly compared.

Methods

CE was defined as the incremental cost effectiveness ratio (ICER), a measure of the cost difference per quality adjusted life years gained (QALY). Markov models were constructed to calculate the ICER of both neoadjuvant nivolumab plus chemotherapy versus neoadjuvant chemotherapy and adjuvant atezolizumab versus standard of care (SOC) (surveillance +/- chemo). For the neoadjuvant nivolumab method, CE was assessed in the intention to treat population (all stage IB-IIIA) and the PD-L1≥1% group. CE of adjuvant atezolizumab was evaluated for the stage II-IIIA PD-L1≥1% and PD-L1≥50% groups. Each of these four clinical scenarios were divided into three sub-scenarios based on the use and assumed effectiveness of immunotherapy (IO) at recurrence in the experimental arms: 1. No IO at recurrence. 2. IO at recurrence but ineffective. 3. IO at recurrence and effective.

Results

The ICERs are in the following table. Probabilistic sensitivity analyses confirmed the results of all primary analyses. Table: 1287P

Conclusions

In eleven of twelve scenarios, the experimental arms were less costly and more effective than the SOC. Only adjuvant atezolizumab used in PD-L1≥1% patients with ineffective IO at recurrence resulted in a cost increase per QALY gained as compared to SOC. Neoadjuvant nivolumab is a more cost-effective treatment strategy than adjuvant atezolizumab even when adjuvant atezolizumab is limited to patients with a PD-L1≥50%, likely due to shorter duration of treatment with nivolumab. Further analyses can be done to confirm CE with publication of final overall survival results.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

N.A. Pennell: Financial Interests, Advisory Board: Merck, Pfizer, Mirati, Eli Lilly, Genentech, Sanofi, Genzyme, Novartis, Bayer, Summit Therapeutics, Anheart. All other authors have declared no conflicts of interest.