OBJECTIVES: The objective of this study was to develop a cost-effectiveness model from a third-party payer perspective to evaluate second-line treatment strategies for NSCLC in the US and to investigate the value of ramucirumab+docetaxel (RAM+DOC) across histological subtypes.
METHODS: Model comparators include the most commonly used second-line treatment regimens for NSCLC for which clinical trial data were available in the squamous, nonsquamous, and overall population. We used a lifetime horizon, 3% cost discounting rate, and semi-Markov structure to account for time-dependent variation in probabilities of progression-free and overall survival. The structure of the model incorporated 21-day cycles and four health states including second-line treatment, third-line treatment, best supportive (palliative) care, and death. Clinical trial data were supplemented by other published data, when necessary. Probabilistic and one-way sensitivity analyses were conducted to test the robustness of findings.
RESULTS: Based on the results of this cost-effectiveness analysis, RAM+DOC in the second-line treatment of patients may be considered a cost-effective option in the nonsquamous populations given an oncology willingness-to-pay threshold of $200,000 per life-year gained (ICER=$192,833 versus docetaxel alone). For the overall NSCLC population, comparators were limited and the incremental cost effectiveness ratio was slightly higher (ICER=$222,224 versus docetaxel). There were very limited data to evaluate the squamous population, and the ICER for RAM+DOC was high. The lack of complete data in the histological subgroups was a limitation; analyses were only possible for a subset of the comparators of interest.
CONCLUSIONS: The treatment patterns and cost data used to inform this model are US-specific and would require adaptation to be generalizable elsewhere. Depending on the threshold used by the decision maker, RAM+DOC may be a cost-effective option for the overall and nonsquamous NSCLC population.
