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\begin{document}

\title{Cost-effectiveness analysis of first-line nivolumab plus ipilimumab
combination therapy for unresectable malignant pleural mesothelioma:
based on a multicenter, phase 3 trial}



\author[1]{Zhaoyan Chen}%
\author[1]{Fangyuan Tian}%
\author[1]{Ya Zeng}%
\affil[1]{Affiliation not available}%


\vspace{-1em}



  
  \date{May 27, 2024}


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\begin{abstract}
Background: Malignant pleural mesothelioma (MPM) is a rare tumor. The
approved systemic treatment of MPM is limited to chemotherapy. The
purpose of this study was to evaluate the economic efficacy of an NIV
plus IPI regimen for the treatment of MPM in China. Methods: The data
estimated were from a multicenter randomized phase III trial that showed
an improved survival benefit in patients with MPM treated with a NIV+IPI
combination regimen. A partitioned survival model was constructed to
estimate the incremental cost--benefit ratio (ICER) from the perspective
of Chinese society. The uncertainty in the model is solved by one-way
certainty and probabilistic sensitivity analysis. Results: Our base case
analysis showed that the total costs of treatment increased from
\$28,833.84 to \$236,590.48 with the NIV+IPI combination regimen versus
platinum plus pemetrexed chemotherapy. Treatment with NIV+IPI
combination therapy was associated with an increase in effectiveness of
0.08 QALYs from 1.08 QALYs to 1.16 QALYs. The incremental
cost-effectiveness ratio was \$2,596,958.00/QALY, with a 0\% probability
of being cost-effective at a WTP threshold of \$36,203.87/QALY. Cost
changes associated with grade 3-4 AE management, tests used, or
hospitalization costs had little effect on the ICER values predicted by
sensitivity analysis. Conclusions: Taken together, the results of this
study suggest that the combination of NIV plus IPI is not a
cost-effective option from the perspective of Chinese payers as a
first-line treatment option for MPM patients in China. Appropriate drug
donation programs and social assistance are necessary.%
\end{abstract}%



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