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Poster Display session

138P - Cost-effectiveness of nivolumab and ipilimumab versus chemotherapy (with and without bevacizumab) in patients with unresectable malignant pleural mesothelioma in Switzerland


31 Mar 2023


Poster Display session


Michaela Barbier


Journal of Thoracic Oncology (2023) 18 (4S): S116-S118.


M.C. Barbier1, A. Fengler2, O. Gautschi3

Author affiliations

  • 1 Basel/CH
  • 2 Cantonal Hospital of Lucerne, Luzern/CH
  • 3 Luzerner Kantonsspital, Luzern/CH


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Abstract 138P


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.


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.


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.


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.


Swiss Institute for Accident Insurance (Suva).


All authors have declared no conflicts of interest.

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