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Cost-effectiveness analysis of nivolumab plus chemotherapy vs chemotherapy for patients with unresectable advanced or metastatic HER2-negative gastric or gastroesophageal junction or esophageal adenocarcinoma in Japan

  • Original Article—Alimentary Tract
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Abstract

Background

This study aimed to evaluate the cost-effectiveness of nivolumab plus chemotherapy (NIVO + Chemo) compared with chemotherapy monotherapy (Chemo) for patients with advanced or metastatic HER2-negative gastric or gastroesophageal junction or esophageal adenocarcinoma (GC/GEJC/EAC) in Japan from the perspective of healthcare payer.

Methods

A partitioned survival analysis model was developed to predict costs and quality-adjusted life years (QALYs) for NIVO + Chemo and Chemo. The time horizon of the model was set to 38 years. An annual discount rate of 2% for both costs and QALYs was applied. Data on overall survival and progression-free survival were derived from the CheckMate649 trial. Cost parameters were estimated from a Japanese medical claims database. The incremental cost-effectiveness ratio (ICER) of NIVO + Chemo compared with Chemo was estimated. A subgroup analysis on the level of PD-L1 CPS expression was conducted. In addition, sensitivity analysis was performed to assess the uncertainty in the parameter settings.

Results

The incremental cost and QALY of NIVO + Chemo compared with Chemo were USD99,416 and 0.30 QALY, respectively. The ICER of NIVO + Chemo was estimated to be USD327,161 per QALY gained. The results of the subgroup analysis showed that ICER was USD247,403/QALY and USD302,183/QALY for PD-L1 CPS ≧ 5 and ≧ 1, respectively. Sensitivity analyses showed a relatively robust result that the ICER remained higher than the Japanese cancer threshold of USD75,000–150,000/QALY.

Conclusions

Applying the Japanese cancer threshold of USD75,000–150,000/QALY, NIVO + Chemo was not cost-effective for patients with advanced or metastatic HER2-negative GC/GEJC/EAC in Japan from the perspective of healthcare payer.

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Authors and Affiliations

  1. Department of Health Informatics, School of Public Health, Kyoto University Graduate School of Medicine, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan

    Kosuke Morimoto & Takeo Nakayama

  2. Comprehensive Unit for Health Economic Evidence Review and Decision Support (CHEERS), Research Organization of Science and Technology, Ritsumeikan University, #215, Research Park Bid. No. 6, 93, Awata-machi, Chudoji, Simogyo-ku, Kyoto, 600-8815, Japan

    Kosuke Morimoto, Kensuke Moriwaki & Kojiro Shimozuma

  3. Division of Health Service Research, Department of Biomedical Science, College of Life Sciences, Ritsumeikan University, 1-1-1, Noji-higashi, Kusatsu, Shiga, 525-8577, Japan

    Kensuke Moriwaki & Kojiro Shimozuma

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Correspondence to Kosuke Morimoto.

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Conflict of interest

Takeo Nakayama received Per diem, honorariums, etc. from Pfizer Japan, Janssen Pharmaceutical K. K., Boehringer Ingelheim, Eli Lilly Japan K. K., Mitsubishi Tanabe Pharma, Dentsu, and Otsuka Pharmaceutica. He also received Research grants from I&H co., Ltd., Cocokarafine Co., Ltd., and Konica Minolta Inc.

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Supplementary Information

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535_2023_2041_MOESM1_ESM.pptx

Supplementary file1 Figure 1. Results of survival curve fitting in PD-L1 CPS ≧ 1. (a) OS and PFS in NIVO+Chemo group, (b) OS and PFS in Chemo group. NIVO+Chemo: Nivolumab plus Chemotherapy, Chemo: Chemotherapy PFS: progression-free survival, PD: Progressive disease. Figure 2. Results of survival curve fitting in PD-L1 CPS ≧ 5. (a) OS and PFS in NIVO+Chemo group, (b) OS and PFS in Chemo group. NIVO+Chemo: Nivolumab plus Chemotherapy, Chemo: Chemotherapy PFS: progression-free survival, PD: Progressive disease (PPTX 141 KB)

Supplementary file2 (DOCX 24 KB)

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Morimoto, K., Moriwaki, K., Shimozuma, K. et al. Cost-effectiveness analysis of nivolumab plus chemotherapy vs chemotherapy for patients with unresectable advanced or metastatic HER2-negative gastric or gastroesophageal junction or esophageal adenocarcinoma in Japan. J Gastroenterol 58, 1188–1197 (2023). https://doi.org/10.1007/s00535-023-02041-3

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  • DOI: https://doi.org/10.1007/s00535-023-02041-3

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