Abstract 138P
Background
Malignant pleural mesotheliomas (MPMs) are aggressive and often unresectable. In the past, chemotherapy was the standard for palliation. Recently, immunotherapy with nivolumab and ipilimumab (nivo+ipi) was approved. This study evaluated the cost-effectiveness of nivo+ipi versus chemotherapy (with and without bevacizumab) for Swiss patients with unresectable MPM, overall and by histological subtype.
Methods
We developed a three-state Markov cohort model with a cycle length of one month, a 30-year time horizon, and a discount rate of 3% for costs and benefits. The model included the updated survival and treatment-dependent utility results from the Checkmate-743 and MAPS registration trials. A Swiss statutory health insurance perspective was considered with unit costs for 2022 from both publicly available and real-world sources. We assumed a willingness-to-pay (WTP) threshold of CHF100'000. Model robustness was explored in sensitivity analyses.
Results
Compared with chemotherapy, nivo+ipi incurred additional costs of CHF104'100 and 0.48 additional quality-adjusted life years (QALYs), yielding an incremental cost-effectiveness ratio (ICER) of CHF217'288/QALY gained. Chemotherapy+bevacizumab was a dominated strategy. Preference of cisplatin over carboplatin led to an ICER of CHF175'057. For the non-epithelioid subtype, the ICER decreased to CHF124'612. Nivo+ipi may be cost-effective if priced at 43% for all histologies and at 79% for non-epithelioid MPM of their 2022 list price.
Conclusions
Substantial discounts for nivo+ipi would be necessary to achieve cost-effectiveness at the Swiss list prices. Accepting a higher WTP threshold, cost-effectiveness would be more likely for non-epithelioid MPM than for all histologies. Chemotherapy+bevacizumab is unlikely to be a cost-effective alternative. [Grant support: SUVA, Lucerne, Switzerland].
Legal entity responsible for the study
The authors.
Funding
Swiss Institute for Accident Insurance (Suva).
Disclosure
All authors have declared no conflicts of interest.