Pharmacoeconomic analysis of perioperative chemo-immunotherapy in resectable stage III non small cell lung cancer (NSCLC): Survival time cost-efficacy based on NADIM 2 trial.

Abstract

e23141 Background: Neoadjuvant and perioperative chemoimmunotherapy is increasingly used in resectable NSCLC. Several trials achieved improvement in EFS and OS and most used a perioperative strategy . There is poor compliance of post-op IT and its duration, cost and value are not well established. Here we report a pharmacoeconomic analysis of NADIM 2 trial. Methods: 86 patients with resectable Stage IIIA/B NSCLC were randomly assigned in a 2:1 ratio to receive 3 cycles of preoperative Nvolumab plus chemotherapy (experimental group, Exp) versus chemotherapy alone (Control group) and after R0 surgery, patients assigned to Exp arm received Nivolumab monthly for 6 months (m). Improvement in OS (secondary end-point) was observed after a median follow-up of 22.6 m. Nivolumab was administered at flat dose of 360 mg preop and 480 mg postop. An intention to treat analysis was performed using patient crude survival time and cost of delivered immunotherapy according to nivolumab price in Spain. Results: Only 2 out of 57 p do not received 3 preoperative treatment cycles. 36/57 p (63%) completed planned postop Nivolumab. 11 p (19%) do not received any postoperative dose. Overall, the delivered doses of Nivolumab achieved 72% of planned treatment. The mean survival in the Exp group was 41.7 m vs 21.3 m in Control with an increase of 20.3 m. Total cost of Nivolumab treatment per protocol accounted for 50,371€, while the cost of delivered treatment was 31,016€. After adjusting for OS, the benefit per patient resulted in 18,299 € per gained year of life. Conclusions: Perioperative chemo-immunotherapy is the current standard of care in resectable Stage III NSCLC and improved OS in NADIM 2 trial. Compliance of post-operative 6 months immunotherapy was 72% of planned dose. Cost per life years gained of 3 cycles pre and 6 cycles postop Nivolumab accounts for 18.299€ below the threshold of cost-effectiveness accepted in most European countries. Clinical trial information: NCT03838159 .