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ORIGINAL RESEARCH article

Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
Volume 15 - 2024 | doi: 10.3389/fimmu.2024.1426024

Cost-Effectiveness of Nivolumab plus Gemcitabine-Cisplatin as First-Line Treatment for Advanced Urothelial Carcinoma in China and the United States

Provisionally accepted
Guiyuan Xiang Guiyuan Xiang 1Yueyue Huang Yueyue Huang 2,3Lanlan Gan Lanlan Gan 1Linning Wang Linning Wang 4Yunqi Ding Yunqi Ding 1Yuanlin Wu Yuanlin Wu 1Haiyan Xing Haiyan Xing 1Yao Liu Yao Liu 1*
  • 1 Daping Hospital, Army Medical University, Chongqing, China
  • 2 Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
  • 3 Chongqing Health Center for Women and Children, Chongqing, Chongqing, China
  • 4 China Pharmaceutical University, Nanjing, Jiangsu Province, China

The final, formatted version of the article will be published soon.

    Objective: Nivolumab, recently proven in a phase 3 clinical trial (CheckMate 901) to enhance survival when combined with gemcitabine-cisplatin for advanced urothelial carcinoma. This study aimed to assess its cost-effectiveness against gemcitabine-cisplatin alone, from US and Chinese payers’ perspectives. Methods: A partitioned survival model was established to assess the life-years, quality-adjusted life-years (QALYs), lifetime costs, and incremental cost-effectiveness ratios (ICERs) of nivolumab plus gemcitabine-cisplatin versus gemcitabine-cisplatin alone as first-line treatment for advanced urothelial carcinoma. Univariate, two-way, and probabilistic sensitivity analyses were conducted to assess the model’s robustness. Additionally, subgroup analyses were performed. Results: Nivolumab plus gemcitabine-cisplatin and gemcitabine-cisplatin achieved survival benefits of 4.238 life-years and 2.979 life-years for patients with advanced urothelial carcinoma, respectively. Compared with gemcitabine-cisplatin, nivolumab plus gemcitabine-cisplatin resulted in ICERs of $116,856/QALY in the US and $51,997/QALY in China. The probabilities of achieving cost-effectiveness at the current willingness-to-pay thresholds were 77.5% in the US and 16.5% in China. Cost-effectiveness could be reached if the price of nivolumab were reduced to $920.87/100mg in China. Subgroup analyses indicated that the combination had the highest probability of cost-effectiveness in patients under 65 or with an Eastern Cooperative Oncology Group (ECOG) performance-status score of 0 in the US and China. Conclusions: Nivolumab plus gemcitabine-cisplatin first-line treatment for advanced urothelial carcinoma results in longer life expectancy than gemcitabine-cisplatin, but is not cost-effective in China at current price. However, cost-effectiveness is likely to be achieved in most patient subgroups in the US.

    Keywords: Nivolumab, urothelial carcinoma, Cost-Effectiveness, gemcitabine, Cisplatin, chemotherapy, partitioned survival model

    Received: 30 Apr 2024; Accepted: 27 Aug 2024.

    Copyright: © 2024 Xiang, Huang, Gan, Wang, Ding, Wu, Xing and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Yao Liu, Daping Hospital, Army Medical University, Chongqing, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.