Journal Article

Cost-Effectiveness of Perioperative Nivolumab for Stage III Non–Small-Cell Lung Cancer: A Perspective From The United States

Zhang, Na, Sun, Jingyi, Chen, Qiong, Dai, Ziyu

2025

Overview

•A Markov model evaluated the cost-effectiveness of perioperative nivolumab in stage III NSCLC.•Nivolumab plus chemotherapy improved QALYs and remained cost-effective under a $150,000/QALY threshold.•Sensitivity analysis confirmed robustness; postoperative nivolumab cost had the greatest ICER impact.•Subgroup analysis showed cost-effectiveness in non-squamous and PD-L1–positive patients, but not in others.•Findings support stratified reimbursement policies and equitable access to immunotherapy in real-world settings. The NADIM II trial demonstrated that combining perioperative nivolumab, an immune checkpoint inhibitor, with intensified chemotherapy significantly enhanced pathological complete response rates and overall survival in patients with surgically resectable stage III non–small-cell lung cancer (NSCLC) compared to those receiving chemotherapy alone. However, concerns persist regarding the substantial cost of immunotherapy. Our study aims to evaluate the cost-effectiveness of neoadjuvant treatment combining nivolumab with chemotherapy versus standard neoadjuvant chemotherapy alone in resectable stage III NSCLC patients within the U.S. healthcare system. Using data from the NADIM II trial, we developed a Markov model with 3 distinct health states to accurately simulate the overall health outcomes of NSCLC patients following different treatment strategies. This model not only computed essential economic metrics such as life years (LY), quality-adjusted life years (QALY), incremental cost-effectiveness ratio (ICER), and total costs but also ensured robustness through sensitivity and subgroup analyses. The group receiving nivolumab plus chemotherapy achieved 7.89 QALYs (9.75 LYs) at a total cost of $428,701.08, whereas the chemotherapy-alone group attained 6.80 QALYs (8.53 LYs) with total costs amounting to $318,550.20. This resulted in an incremental cost of $110,150.88. Considering a willingness-to-pay (WTP) threshold of $150,000/QALY in the United States, the ICER was determined to be $100,879.21/QALY ($90,193.76/LY). Based on these findings, in the United States, the perioperative use of nivolumab combined with chemotherapy appears to be cost-effective compared to chemotherapy alone for patients with stage III NSCLC, given a WTP threshold of $150,000/QALY.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Adjuvants / Antineoplastic Combined Chemotherapy Protocols - economics / Antineoplastic Combined Chemotherapy Protocols - therapeutic use / Cancer therapies / Carcinoma, Non-Small-Cell Lung - drug therapy / Carcinoma, Non-Small-Cell Lung - economics / Carcinoma, Non-Small-Cell Lung - mortality / Carcinoma, Non-Small-Cell Lung - pathology / Chemotherapy / Cost analysis / Cost-Benefit Analysis / Diarrhea / Female / Humans / Immune checkpoint inhibitors / Immunotherapy / Incremental cost-effectiveness ratio / Internal Medicine / Lung cancer / Lung Neoplasms - drug therapy / Lung Neoplasms - economics / Lung Neoplasms - mortality / Lung Neoplasms - pathology / Male / Markov Chains / Neoadjuvant Therapy - economics / Neoadjuvant Therapy - methods / Neoplasm Staging / Neutropenia / Nivolumab / Nivolumab - administration & dosage / Nivolumab - economics / Nivolumab - therapeutic use / Non-small cell lung carcinoma / Palliative care / Patients / Perioperative / Perioperative care / Quality of life / Quality-Adjusted Life Years / Response rates / Sensitivity analysis / Simulation / Small cell lung carcinoma / Stage III non–small-cell lung cancer / Surgery / United States / Willingness to pay