OBJECTIVES: Switzerland recently approved and reimbursed nivolumab as the first adjuvant treatment for patients with resected esophageal cancer (EC) or gastroesophageal junction cancer (GEJC). A phase 3 randomised controlled trial (CM577) comparing nivolumab with placebo in patients with resected EC or GEJC found that nivolumab was associated with 31% lower risk of recurrence or death and double the median disease-free survival compared with placebo. We evaluated the cost-utility of nivolumab compared with placebo from a Swiss compulsory health insurance system perspective.
METHODS: A three-state Markov model (pre-recurrence, post-recurrence, and death) was developed to evaluate the cost utility of nivolumab compared with placebo over 25 years. Transition probabilities and utilities were based on the clinical trial, published literature, and real-world registry data. Resource use and costs were derived from Swiss inpatient (Swiss DRG) and outpatient (TARMED) tariff systems and expert interviews. Drug prices were obtained from the Federal Office of Public Health list of specialties. Costs and utilities were discounted 3.0% annually. Deterministic and probabilistic sensitivity analyses were conducted.
RESULTS: Base-case results showed patients taking nivolumab had incremental costs of CHF 60,751 and incremental quality-adjusted life-year (QALY) gains of 1.60 (life-year gain, 1.90) for an incremental cost-utility ratio of CHF 37,986 per QALY gained (cost per life-year gained, CHF 31,953). The probabilistic analysis with 1,000 simulations found a mean incremental cost-utility ratio of nivolumab compared with placebo of CHF 37,381/QALY and that nivolumab has a 98% probability of being cost-effective at a willingness-to-pay threshold of CHF 100,000/QALY.
CONCLUSIONS: Nivolumab is the first reimbursed adjuvant treatment option available for patients with resected EC or GEJC in Switzerland. We showed nivolumab has the potential to generate substantial long-term pharmacoeconomic benefits. With a willingness-to-pay threshold of CHF 100,000/QALY, nivolumab appears to be a cost-effective treatment for patients with resected EC or GEJC in Switzerland.
