The SQUIRE trial demonstrated that adding necitumumab to chemotherapy for patients with metastatic squamous (mSq) NSCLC produces a median overall survival benefit of 1.6 months (hazard ratio 0.84).1 The objective of the current study by Goldstein and colleagues was to evaluate the range of drug costs for which adding necitumumab to chemotherapy could be considered cost-effective.2 The authors developed a Markov model to compare the incremental cost-effectiveness of standard chemotherapy with or without necitumumab in the first-line treatment of mSqNSCLC. In the model, patients received gemcitabine and cisplatin for 6 cycles or gemcitabine, cisplatin, and necitumumab for 6 cycles followed by maintenance necitumumab. The clinical inputs were the survival benefits and frequency of adverse events (AEs) described in the SQUIRE trial. The cost inputs included drug costs based on the Medicare average sale prices, and costs for drug administration and the management of AEs based on Medicare reimbursement rates (all in 2014 US $). In the base case analysis, the addition of necitumumab produced an incremental survival benefit of 0.15 life years (LY) and 0.11 quality-adjusted life years (QALYs). The probability sensitivity analyses established that when necitumumab cost was < $563 per cycle, there was 90% confidence that the incremental cost-effectiveness ratio (ICER) for adding necitumumab would be < $100,000/QALY; when necitumumab cost was $1309 per cycle, there was 90% confidence that the ICER would be < $200,000/QALY; and when the cost of necitumumab was > $6,628 per cycle, there was > 99% confidence that the ICER would be > $500,000/QALY. These findings provide a value-based range for the cost of necitumumab from $563 to $1309 per cycle. This study also provides a framework for establishing value based pricing for new oncology drugs entering the US marketplace.
