Details regarding cost-effectiveness studies of head and neck cancers

Reference, Country, YearComparisonMethodologyaCostsQALYsICERWTPConclusionsCriticisms
Ward et al., USA, 2017 [25]Nivo vs. standard (choice of cetux, doc, or MTX) for recurrent/metastatic HNCMarkov; PD-L1 cutoff ≥1%; accounted for toxicity, administration, end-of-life costs$73,463 nivo, $26,133 standard0.626 nivo, 0.289 standardRelative to standard, nivo $140,672/QALY; nivo with PD-L1 testing $131,066/QALY; relative to cetux, nivo $89,786/QALY; relative to MTX, nivo $154,411/QALY; relative to doc, nivo $154,191/QALY$100,000/QALYNivo not CE in this setting; PD-L1 testing minimally influences results- Although per prospective data, heterogeneity of “standard” cohort using several different agents difficult to interpret, and not necessarily representative of practice patterns- Disutility scores based on weaker, non-prospective data- Lack of accountability for grade < 3 toxicities or p16 disease
Zargar et al., Canada, 2018 [26]Nivo vs. doc for recurrent/metastatic HNCMarkov; accounted for PD-L1, toxicity, and end-of-life costsCAD 60,035 ($46,563) nivo, CAD 41,212 ($31,964) doc0.248 nivo, 0.130 docRelative to doc, nivo CAD 144,744 ($112,263)/QALYCAD 100,000 ($78,385)/QALYAlthough numerically more favorable in younger, p16+, PD-L1 > 5% patients, nivo not CE- Although prospective trial data used, that trial did not utilize single-agent docetaxel as in this study, but rather a combination of three agents- Did not account for administration costs- Only grade ≥ 3 toxicities accounted for, as a one-time cost
Tringale et al., USA, 2018 [27]Nivo vs. standard (choice of cetux, doc, or MTX) for recurrent/metastatic HNCMarkov; accounted for toxicity, administration, societal, and end-of-life costs$174,800 nivo, $57,000 standard0.796 nivo, 0.396 standardRelative to standard, nivo $294,400/QALY; relative to cetux, nivo $182,200/QALY$100,000/QALYNivo not CE in this setting- Overall modeling horizon of 30 years, when exceedingly low numbers of patients still alive, causing errors in survival extrapolation and thus costs- Only grade ≥ 3 toxicities accounted for, as a one-time cost- Did not consider PD-L1 status or p16 disease

QALY quality-adjusted life year, ICER incremental cost-effectiveness ratio, WTP willingness to pay (threshold); nivo, nivolumab; cetux, cetuximab; doc, docetaxel, MTX methotrexate, HNC head and neck cancers, CE cost-effective, PD-L1 programmed cell death ligand-1, CAD Canadian dollar

aAll studies consisted of three basic health states (progression-free (stable), progressive disease, and death); all studies performed sensitivity analyses in addition to the base case