Table 4.
Cost-effectiveness analyses results
| QALDsa | Costb | NMBc | Probability NEPA is cost-effective at a WTP per QALY of: | ||||||
|---|---|---|---|---|---|---|---|---|---|
| Analysis | NEPA | APR + GRAN | Difference (95% CI) | NEPA | APR + GRAN | Difference (95% CI) | $25,000 | $100,000 | |
| Base-case | 4.04 | 3.95 | 0.09 (−0.06 to 0.25) | $943 | $1252 | $309 ($4 to $626) | $315 | 97.8% | 98.0% |
| Sensitivity analyses | |||||||||
| − 25% study drug cost | 4.04 | 3.95 | 0.09 (−0.06 to 0.25) | $943 | $1241 | $298 (−$8 to $614) | $304 | 97.4% | 97.6% |
| + 25% study drug cost | 4.04 | 3.95 | 0.09 (−0.06 to 0.25) | $943 | $1264 | $320 ($15 to $637) | $326 | 98.2% | 98.2% |
| − 25% HCRU cost | 4.04 | 3.95 | 0.09 (−0.06 to 0.25) | $841 | $1085 | $245 ($15 to $488) | $251d | 98.3%d | 98.5%d |
| + 25% HCRU cost | 4.04 | 3.95 | 0.09 (−0.06 to 0.25) | $1046 | $1419 | $374 (−$8 to $762) | $380d | 97.4%d | 97.6%d |
| HCRU cost truncated at 6 days | 4.04 | 3.95 | 0.09 (−0.06 to 0.25) | $748 | $934 | $186 ($26 to $357) | $192 | 98.9% | 99.1% |
| − 50% of 6-day HCRU cost | 4.04 | 3.95 | 0.09 (−0.06 to 0.25) | $641 | $759 | $118 ($38 to $217) | $124 | 99.8% | 99.7% |
| ITT population | 4.01 | 3.94 | 0.07 (−0.06 to 0.24) | $1028 | $1249 | $221 (−$80 to $551) | $226 | 93.2% | 93.6% |
| Threshold for severe nausea | |||||||||
| VAS = 70 | 4.04 | 3.95 | 0.09 (−0.06 to 0.25) | $1112 | $1586 | $474 ($120 to $857) | $480 | 99.5% | 99.5% |
| VAS = 90 | 4.04 | 3.95 | 0.09 (−0.06 to 0.25) | $799 | $1014 | $215 (−$43 to $460) | $221 | 95.1% | 95.7% |
| > 8.5 h vomiting and/or retching | 4.04 | 3.95 | 0.09 (−0.06 to 0.25) | $727 | $1229 | $502 ($248 to $802) | $508 | 100.0% | 100.0% |
| Subgroups | |||||||||
| Metastatic disease | 4.06 | 3.80 | 0.26 (−0.07 to 0.46) | $1041 | $1690 | $649 ($276 to $1026) | $667 | 100.0% | 100.0% |
| Non-metastatic disease | 4.02 | 4.02 | 0.00 (−0.13 to 0.13) | $870 | $1040 | $169 (−$117 to $415) | $169 | 86.0% | 85.5% |
| Lung cancer | 4.13 | 4.00 | 0.14 (−0.03 to 0.28) | $857 | $1143 | $285 ($8 to $573) | $295 | 98.2% | 98.5% |
| No lung cancer | 3.85 | 3.86 | −0.01 (−0.16 to 0.15) | $1115 | $1449 | $333 (−$45 to $659) | $332 | 95.2% | 94.5% |
APR, aprepitant; CI, confidence interval; GRAN, granisetron; HCRU, healthcare resource use; ITT, intent-to-treat; NEPA, netupitant and palonosetron; NMB, net monetary benefit; QALD, quality-adjusted life-day; QALY, quality-adjusted life-year; VAS, visual analogue scale; WTP, willingness to pay
aFor reference, the QALDs of 5 days of complete protection (CP) are 4.5
bAdjusted to 2018 US dollars
cDefined as (QALD difference ÷ 365.25 × $25,000 - cost difference). A positive NMB implies NEPA is cost-effective at the $25,000 per QALY threshold. The higher the NMB, the more cost-effective NEPA is
dThe NMB is higher (i.e., better for NEPA) when CINV costs are higher, reflecting the fact that NEPA on average prevents CINV. However, the percentage of model simulations in which NEPA is cost-effective appears lower when CINV costs are higher. This reflects the uncertainty/variability in the percentage difference in patients with severe nausea