Cost-effectiveness analysis of nivolumab plus ipilimumab versus chemotherapy as the first-line treatment for unresectable malignant pleural mesothelioma

Our plain-English summary of Cost-effectiveness analysis of nivolumab plus ipilimumab versus chemotherapy as the first-line treatment for unresectable malignant pleural mesothelioma, by L. Yang, X. Cao, N. Li, et al (Therapeutic Advances in Medical Oncology, 2022).

The study

• Authors: L. Yang, X. Cao, N. Li, B. Zheng, M. Liu, H. Cai
• Journal: Therapeutic Advances in Medical Oncology
• Published: 2022;14:17588359221116604
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: This study evaluated the cost-effectiveness of nivolumab plus ipilimumab (NI) versus pemetrexed plus cisplatin/carboplatin (C) as the first-line treatment for unresectable malignant pleural mesothelioma (MPM) from the perspective of US payers.

Methods: A 10-year partitioned survival model was constructed using survival and safety data from the CheckMate 743 clinical trial. The output metrics of the model included the patient's lifetime quality-adjusted life years (QALYs), lifetime costs, and incremental cost-effectiveness ratio (ICER). Only direct medical costs were considered. One-way and probabilistic sensitivity analyses were conducted to assess the robustness of the results.

Results: Among all randomized patients, group NI had an ICER of $475,677/QALY relative to group C. Among patients with epithelioid histology, group NI had an ICER of $760,955/QALY. Among patients with non-epithelioid histology, group NI had an ICER of $418,348/QALY. The ICERs of all three populations exceeded the willingness-to-pay threshold ($150,000). The results of one-way sensitivity analysis revealed that the cost of nivolumab had a great influence on the results. The results of probabilistic sensitivity analysis demonstrated that the possibility of NI being more economical in all randomized patients and in patients with non-epidemiology histology was 0. In patients with epithelioid histology, the probability that NI had an economic advantage was 0.6%.

Conclusions: From the perspective of US payers, in patients with unresectable MPM, NI has no economic advantage over C.

© The Author(s), 2022.

In plain English

This was a cost-effectiveness model, not a study of asbestos exposure. Using survival and side-effect data from the CheckMate 743 trial, the authors built a 10-year model comparing nivolumab plus ipilimumab with pemetrexed plus cisplatin or carboplatin as first-line treatment for unresectable malignant pleural mesothelioma, from the US payer perspective. In all randomized patients, nivolumab plus ipilimumab gave 1.45 quality-adjusted life years versus 1.19 for chemotherapy, at total costs of $295,988 versus $168,111. That worked out to $475,677 per extra quality-adjusted life year. This figure was $760,955 for patients with epithelioid histology and $418,348 for non-epithelioid histology, all above the $150,000 threshold the authors used. Changing one input at a time within the authors' tested ranges did not bring the figure below that threshold. In repeated simulations, the probability that the combination was cost-effective at $150,000 was 0 for all randomized and non-epithelioid patients and 0.6% for epithelioid patients. The authors concluded it had no economic advantage over chemotherapy. They noted that progression data for the subgroups were unavailable and that quality-of-life values came from non-small-cell lung cancer studies.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Cost-effectiveness analysis using a 10-year partitioned survival model built on published data from the CheckMate 743 clinical trial
• Who was studied: Modelled patients matching the CheckMate 743 trial: adults with unresectable malignant pleural mesothelioma. The trial groups were 303 nivolumab plus ipilimumab versus 302 chemotherapy patients overall, 229 versus 226 with epithelioid histology, and 74 versus 76 with non-epithelioid histology. The analysis took the US payer perspective.
• Exposure: Not asbestos exposure. The comparison was between two treatments: nivolumab plus ipilimumab versus pemetrexed plus cisplatin or carboplatin, as first-line treatment.
• Main results:
  • All randomized patients: nivolumab plus ipilimumab gave 1.45 QALYs versus 1.19 QALYs for chemotherapy, with total costs of $295,988 versus $168,111. The ICER was $475,677/QALY.
  • Patients with epithelioid histology: 1.48 QALYs versus 1.34 QALYs, with total costs of $313,857 versus $205,508. The ICER was $760,955/QALY.
  • Patients with non-epithelioid histology: 1.25 QALYs versus 0.79 QALYs, with total costs of $268,724 versus $72,783. The ICER was $418,348/QALY.
  • In one-way sensitivity analysis, each input was varied one at a time within the authors' tested ranges: generally 20% above or below baseline, with nivolumab and ipilimumab prices lowered by up to 50% and the discount rate varied from 0% to 6%. In all three populations, the ICER stayed above the $150,000 willingness-to-pay threshold.
  • In probabilistic sensitivity analysis, the probability that nivolumab plus ipilimumab was economical at a $150,000 threshold was 0 for all randomized patients and for non-epithelioid patients.
  • For patients with epithelioid histology, the probability that nivolumab plus ipilimumab was economical at a $150,000 threshold was 0.6%.
• The authors' conclusion: The authors concluded that, at a $150,000 willingness-to-pay threshold, nivolumab plus ipilimumab had no economic advantage over chemotherapy in the first-line treatment of unresectable malignant pleural mesothelioma.
• Limitations the authors state:
  • The trial did not provide progression-free survival curves for the subgroups, so the all-randomized curve was used for every population. The authors said this would lead to some bias.
  • Only some adverse events were included, to simplify the model, and adverse-event costs came from published literature rather than real-world data.
  • No specific immune-related adverse events were included.
  • Utility (quality-of-life) values were taken from published non-small-cell lung cancer values, because precise mesothelioma values were not available.
  • Adverse-event costs were not discounted.

Topics

Medical terms in this study, explained in our Lexicon: Nivolumab (Opdivo), Ipilimumab (Yervoy), Chemotherapy, Unresectable, Pleural Mesothelioma, Pemetrexed (Alimta), Cisplatin, Carboplatin.

Related studies

• Cost-effectiveness of nivolumab plus ipilimumab as first-line treatment for American patients with unresectable malignant pleural mesothelioma — Z.M. Ye, Z.Q. Tang, et al. (2022)
• First-line nivolumab plus ipilimumab for unresectable MPM in China: a cost-effectiveness analysis — L. Yang, X. Song, et al. (2023)
• Five-Year Clinical Outcomes With Nivolumab Plus Ipilimumab Versus Chemotherapy as First-Line Treatment for Unresectable Pleural Mesothelioma in CheckMate 743 — A. Scherpereel, P. Baas, et al. (2026)
• Cost Effectiveness and Budget Impact of Nivolumab Plus Ipilimumab Versus Platinum Plus Pemetrexed (with and Without Bevacizumab) in Patients with Unresectable Malignant Pleural Mesothelioma in Switzerland — M.C. Barbier, A. Fengler, et al. (2023)
• Safety of First-Line Nivolumab Plus Ipilimumab in Very Old (≥ 80 Years) Patients With Unresectable Malignant Pleural Mesothelioma: A Retrospective Single-Center Case Series — T. Shimamoto, Y. Morimoto, et al. (2024)
• Cost-effectiveness analysis of pembrolizumab plus chemotherapy versus chemotherapy in untreated advanced pleural mesothelioma in the Chinese healthcare system — W. Lang, Y. He, et al. (2024)

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