Cost effectiveness of first line nivolumab plus bevacizumab and chemotherapy for advanced non squamous non small cell lung cancer

The cost-effectiveness of nivolumab plus bevacizumab and chemotherapy for patients with advanced non-squamous non-small-cell lung-cancer (NSCLC) was uncleared yet. The current analysis aimed to evaluate the cost-effectiveness of nivolumab plus bevacizumab and chemotherapy compared with bevacizumab plus chemotherapy for patients with untreated non-squamous NSCLC in Chinese context. A partitioned survival model that simulated 3-week patients transition in 20-year time horizon was conducted to evaluate the economic value. The clinical data were obtained from TASUKI-52 trial, cost and utility values were gathered from the local charges and previously published studies. Sensitivity analyses were conducted to examine the robustness of the model results when parameters changed, subgroup analyses were also conducted to enhance the comprehensiveness of the analysis. Nivolumab plus bevacizumab and chemotherapy yielded an additional 0.90 QALYs with the marginal cost of $231,948.33, resulting in the incremental cost-effectiveness ratio (ICER) of $256,791.53 per additional quality-adjusted life-years (QALYs) gained, which higher than the Chinese willingness-to-pay (WTP) threshold of $39,057/QALY. Sensitivity analyses confirmed the robustness of the model outcomes. Subgroup analyses revealed that nivolumab plus bevacizumab and chemotherapy was unlikely to be the cost-effective option for all subgroups due to the unfavorable ICERs. Nivolumab plus bevacizumab and chemotherapy was unlikely to be the cost-effective first-line therapy for untreated advanced non-squamous NSCLC patients compared with bevacizumab plus chemotherapy from the perspective of Chinese health-care system.