Cost-effectiveness of nivolumab plus chemotherapy for advanced gastric/gastroesophageal junction/esophageal adenocarcinoma in the United States

Nivolumab, in combination with chemotherapy, significantly improves survival in patients with gastric/gastroesophageal junction (G/GEJ)/esophageal adenocarcinoma. The study evaluated the cost-effectiveness of nivolumab plus chemotherapy for the treatment of G/GEJ/esophageal adenocarcinoma. A Markov model was developed from the perspective of United States healthcare payers. We estimated costs and summarized effectiveness in terms of quality-adjusted life-years (QALYs). One-way and probabilistic sensitivity analyses were conducted to assess the impact of uncertainties on the cost-effectiveness results. The incremental cost-effectiveness ratio for nivolumab plus chemotherapy ($149,636.97, 1.24 QALYs) compared to chemotherapy alone ($13,941.06, 0.75 QALYs) is $135,695.91, with a difference of 0.49 QALYs. Evidence suggests that nivolumab plus chemotherapy for the first-line treatment of locally advanced or metastatic G/GEJ/esophageal adenocarcinoma may not represent a cost-effective option within the United States healthcare system.