Nivolumab-ipilimumab combination therapy was not cost effective as a first-line treatment for advanced non-small cell lung cancer (NSCLC), according to results of an economic evaluation study, published in JAMA Network Open.

After publication of the CheckMate 227 clinical trial, which stated that nivolumab-ipilimumab was a cost-effective treatment strategy despite the fact it is marketed at a more expensive rate than chemotherapy, researchers from University of California, San Diego set out to validate this claim. Data from the trial were tested using a Markov model to simulate clinical outcomes and costs. Chemotherapy costs were calculated by summing the average wholesale price of each drug.

The investigators found that nivolumab-ipilimumab associated with a $377,400 cost compared with $175,500 for chemotherapy. The increase in quality-adjusted life years (QALYs) gained from nivolumab-ipilimumab was 1.68 compared with 1.18 for chemotherapy. These values corresponded with an incremental cost-effectiveness ratio (ICER) of $401,700, which far exceeded the willingness-to-pay threshold of $100,000 per QALY.

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For nivolumab-ipilimumab to be considered cost-effective, the monthly price would need to decrease by 80.9%, from $26,425 to $5058.

Incorporating data that nivolumab-ipilimumab was associated with a decreased risk for mortality (hazard ratio [HR], 0.73; 95% CI, 0.64-0.84) into the model, ICER decreased to $249,300 per QALY, still above the predefined threshold.

The investigators observed that chemotherapy was the more cost-effective therapy in 99.9% of scenarios with a $100,000 per QALY cut-off.

This study may have been biased by sourcing data from a single clinical trial.

The study authors failed to confirm that nivolumab-ipilimumab was cost-effective compared with chemotherapy as a first-line treatment of advanced NSCLC.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Courtney PT, Yip AT, Cherry DR, Salans MA, Kumar A, Murphy JD. Cost-effectiveness of nivolumab-ipilimumab combination therapy for the treatment of advanced non–small cell lung cancer. JAMA Netw Open. 2021;4(5):e218787. doi:10.1001/jamanetworkopen.2021.8787.