Cost-effectiveness analysis of Nivolumab plus Ipilimumab versus Nivolumab monotherapy in previously treated metastatic colorectal cancer patients with DNA mismatch repair-deficient/microsatellite instability-high (dMMR/MSI-H) in China.

This study evaluated the cost-effectiveness of Nivolumab plus Ipilimumab versus Nivolumab monotherapy in previously treated metastatic colorectal cancer (CRC) patients with DNA mismatch repair-deficient/microsatellite instability-high (dMMR/MSI-H) in China. An economic evaluation using a three-state partitioned survival model assessed the cost-effectiveness of Nivolumab plus Ipilimumab versus Nivolumab monotherapy. The Kaplan-Meier curves for overall survival and progression-free survival from a clinical trial were digitally extracted, and the Weibull model was applied to extrapolate long-term survival. The anticipated cost and utility of the Nivolumab plus Ipilimumab arm exceeded those of the Nivolumab monotherapy arm, respectively (322,575.67 USD vs. 188,409.23 USD; 3.88 QALYs vs. 2.57 QALYs).

The ICER was 102,646.86 USD/QALY, suggesting that Nivolumab plus Ipilimumab was not cost-effective compared to Nivolumab monotherapy as the late-line treatment for metastatic CRC patients with dMMR/MSI-H. Nivolumab plus Ipilimumab was not cost-effective compared to Nivolumab monotherapy in previously treated metastatic CRC patients with dMMR/MSI-H in China. Colorectal cancer (CRC) is one of the most common cancers globally. CRC is the second most prevalent form of cancer in China.

One well-described genetic subset of CRC is tumors with DNA mismatch-repair deficiency (dMMR)/microsatellite instability-high (MSI-H), which are found in 15% of all patients with CRC. According to the National Comprehensive Cancer Network (NCCN) guideline (Colon Cancer, version 3, 2025), the therapy regimen for advanced or metastatic CRC patients with MSI-H was the checkpoint inhibitor. The checkpoint inhibitor therapy options include Nivolumab ± Ipilimumab. Although some studies showed Nivolumab plus Ipilimumab had the superior progression-free survival versus Nivolumab monotherapy across all treatment lines, with a manageable safety profile, in patients with MSI-H/dMMR metastatic CRC, the pharmacoeconomic evaluation between Nivolumab plus Ipilimumab and Nivolumab monotherapy was not clear.

This study evaluated the cost-effectiveness of Nivolumab plus Ipilimumab versus Nivolumab monotherapy in previously treated metastatic CRC patients withdMMR/MSI-H in China. An economic evaluation using a three-state partitioned survival model assessed the cost-effectiveness of Nivolumab plus Ipilimumab versus Nivolumab monotherapy. The Kaplan–Meier curves for overall survival and progression-free survival from a clinical trial were digitally extracted, and the Weibull model was applied to extrapolate long-term survival.

Our study found that Nivolumab plus Ipilimumab was not cost-effective compared to Nivolumab monotherapy in previously treated metastatic CRC patients with dMMR/MSI-H in China.