Nivolumab (Opdivo) for Metastatic Melanoma

The main factors affecting the clinical effect estimates were the sources of evidence for overall survival, and the assumptions made in the extrapolation of the benefit in a lifetime horizon. [...] When this modification is made, the extra cost and effect of nivolumab is $123,608 and 0.861 QALYs, resulting in an increase in the ICER to $143,564/QALY • In addition to the assumption above, the EGP assumed treatment discontinuation for ipilimumab will follow the same pattern as in the Checkmate-067[1], where patients could be discontinuing treatment with ipilimumab before they reach the full 4 [...] When this modification is made, the extra cost and effect of nivolumab is $103,186 and 0.603 QALYs with an ICER of $171,189/QALY • A combination of the reduced time horizon and the assumption of a log-logistic distribution for the extrapolation of overall survival was made by the EGP. [...] When this modification is made, the extra cost and effect of nivolumab is $125,670 and 0.893 QALYs with an ICER of $140,756/QALY • Note that due to the structure of the model submitted, a change in the time to treatment discontinuation has an effect on both the estimates of incremental costs and QALYs gained. [...] When both modifications were made, the extra cost and effect of nivolumab was $111,725 and 0.841 QALYs resulting in an ICER of $132,809/QALY • A combination of the reduced time horizon and the assumption of treatment discontinuation probability that follows the same trend as that of CheckMate 066[4] was made by the EGP.