***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background We evaluated the cost-effectiveness of nivolumab versus everolimus in patients with advanced renal cell carcinoma ( RCC ) from a US payer perspective . Methods A partitioned survival model consisting of three health states , progression-free survival ( PFS ) , progressive disease , and death , was developed to evaluate the cost-effectiveness of intravenous nivolumab versus oral everolimus over a lifetime . The proportion of patients in each state was calculated based on parametric distributions fitted to PFS and overall survival ( OS ) data from CheckMate 025 ( N = 821 ) , a large r and omized phase 3 trial of nivolumab versus everolimus for advanced RCC . Health state utility data were derived from CheckMate 025 EQ-5D data . Scenario analyses and deterministic and probabilistic sensitivity analyses assessed the impact of uncertainty in model inputs on outcomes . Results Over a 25-year lifetime horizon , treatment with nivolumab result ed in a gain of 0.64 quality -adjusted life-years ( QALYs ) versus everolimus . Nivolumab had greater total costs versus everolimus ( $ US197,089 vs. $ US163,902 ) , mainly due to higher acquisition costs . The incremental cost-utility ratio ( ICUR ) , a measure of incremental costs divided by incremental QALYs , was $ US51,714 per QALY gained for nivolumab versus everolimus , and an incremental cost-effectiveness ratio was $ US44,576 per life-year gained for nivolumab versus everolimus . In sensitivity analyses , average body weight had the greatest impact on the ICUR for nivolumab versus everolimus ( base case $ US51,714 ; range $ US8863–$US94,566 ) . At a $ US150,000 willingness-to-pay ( WTP ) threshold , nivolumab had a 91.7 % probability of being cost-effective versus everolimus . Conclusions In the United States , at a WTP threshold of $ US150,000 per QALY , nivolumab was found to be cost-effective . Key drivers of cost-effectiveness were survival inputs for OS and the average weight of patients ; the latter directly affects nivolumab drug acquisition cost Background Nivolumab was the first programmed death receptor 1 ( PD-1 ) immune checkpoint inhibitor to demonstrate long-term survival benefit in a clinical trial setting for advanced melanoma patients . Objective To evaluate the cost effectiveness of nivolumab monotherapy for the treatment of advanced melanoma patients in Engl and . Methods A Markov state-transition model was developed to estimate the lifetime costs and benefits of nivolumab versus ipilimumab and dacarbazine for BRAF mutation-negative patients and versus ipilimumab , dabrafenib , and vemurafenib for BRAF mutation-positive patients . Covariate-adjusted parametric curves for time to progression , pre-progression survival , and post-progression survival were fitted based on patient-level data from two trials and long-term ipilimumab survival data . Indirect treatment comparisons between nivolumab , ipilimumab , and dacarbazine were informed by these covariate-adjusted parametric curves , controlling for differences in patient characteristics . Kaplan – Meier data from the literature were digitised and used to fit progression-free and overall survival curves for dabrafenib and vemurafenib . Patient utilities and re source use data were based on trial data or the literature . Patients are assumed to receive nivolumab until there is no further clinical benefit , assumed to be the first of progressive disease , unacceptable toxicity , or 2 years of treatment . Results Nivolumab is the most cost-effective treatment option in BRAF mutation-negative and mutation-positive patients , with incremental cost-effectiveness ratios of £ 24,483 and £ 17,362 per quality -adjusted life year , respectively . The model results are most sensitive to assumptions regarding treatment duration for nivolumab and the parameters of the fitted parametric survival curves . Conclusions Nivolumab is a cost-effective treatment for advanced melanoma patients in Engl and BACKGROUND Nivolumab , a fully human IgG4 programmed death 1 ( PD-1 ) immune-checkpoint-inhibitor antibody , disrupts PD-1-mediated signaling and may restore antitumor immunity . METHODS In this r and omized , open-label , international phase 3 study , we assigned patients with nonsquamous non-small-cell lung cancer ( NSCLC ) that had progressed during or after platinum-based doublet chemotherapy  to receive nivolumab at a dose of 3 mg per kilogram of body weight every 2 weeks or docetaxel at a dose of 75 mg per square meter of body-surface area every 3 weeks . The primary end point was overall survival . RESULTS Overall survival was longer with nivolumab than with docetaxel .  The median overall survival was 12.2 months ( 95 % confidence interval [ CI ] , 9.7 to 15.0 ) among 292 patients in the  nivolumab group and 9.4 months ( 95 % CI , 8.1 to 10.7 ) among 290 patients in the docetaxel group ( hazard ratio for death , 0.73 ; 96 % CI , 0.59 to 0.89 ; P=0.002 ) . At 1 year , the overall survival rate was 51 % ( 95 % CI , 45 to 56 ) with nivolumab versus 39 % ( 95 % CI , 33 to 45 ) with docetaxel . With additional follow-up , the overall survival rate at 18 months was 39 % ( 95 % CI , 34 to 45 ) with nivolumab versus 23 % ( 95 % CI , 19 to 28 ) with docetaxel . The response rate was 19 % with nivolumab versus 12 % with docetaxel ( P=0.02 ) . Although progression-free survival did not favor nivolumab over docetaxel ( median , 2.3 months and 4.2 months , respectively ) , the rate of progression-free survival at 1 year was higher with nivolumab than with docetaxel ( 19 % and 8 % , respectively ) . Nivolumab was associated with even greater efficacy  than docetaxel across all end points in subgroups defined according to prespecified levels of tumor-membrane expression ( ≥1 % , ≥5 % , and ≥10 % ) of the PD-1 lig and . Treatment-related adverse events of grade 3 or 4 were reported in 10 % of the patients in the nivolumab group , as compared with 54 % of those in the docetaxel group . CONCLUSIONS Among patients with advanced nonsquamous NSCLC that had progressed during or after platinum-based chemotherapy  , overall survival was longer with nivolumab than with docetaxel . ( Funded by Bristol-Myers Squibb ; CheckMate 057 Clinical Trials.gov number , NCT01673867 . ) BACKGROUND Nivolumab , a fully human IgG4 PD-1 immune checkpoint inhibitor antibody , can result in durable responses in patients with melanoma who have progressed after ipilimumab and BRAF inhibitors . We assessed the efficacy and safety of nivolumab compared with investigator 's choice of chemotherapy ( ICC ) as a second-line or later-line treatment in patients with advanced melanoma . METHODS In this r and omised , controlled , open-label , phase 3 trial , we recruited patients at 90 sites in 14 countries . Eligible patients were 18 years or older , had unresectable or metastatic melanoma , and progressed after ipilimumab , or ipilimumab and a BRAF inhibitor if they were BRAF(V 600 ) mutation-positive . Participating investigators r and omly assigned ( with an interactive voice response system ) patients 2:1 to receive an intravenous infusion of nivolumab 3 mg/kg every 2 weeks or ICC ( dacarbazine 1000 mg/m(2 ) every 3 weeks or paclitaxel 175 mg/m(2 ) combined with carboplatin area under the curve 6 every 3 weeks ) until progression or unacceptable toxic effects . We stratified r and omisation by BRAF mutation status , tumour expression of PD-L1 , and previous best overall response to ipilimumab . We used permuted blocks ( block size of six ) within each stratum . Primary endpoints were the proportion of patients who had an objective response and overall survival . Treatment was given open-label , but those doing tumour assessment s were masked to treatment assignment . We assessed objective responses per- protocol after 120 patients had been treated with nivolumab and had a minimum follow-up of 24 weeks , and safety in all patients who had had at least one dose of treatment . The trial is closed and this is the first interim analysis , reporting the objective response primary endpoint . This study is registered with Clinical Trials.gov , number NCT01721746 . FINDINGS Between Dec 21 , 2012 , and Jan 10 , 2014 , we screened 631 patients , r and omly allocating 272 patients to nivolumab and 133 to ICC . Confirmed objective responses were reported in 38 ( 31·7 % , 95 % CI 23·5 - 40·8 ) of the first 120 patients in the nivolumab group versus five ( 10·6 % , 3·5 - 23·1 ) of 47 patients in the ICC group . Grade 3 - 4 adverse events related to nivolumab included increased lipase ( three [ 1 % ] of 268 patients ) , increased alanine aminotransferase , anaemia , and fatigue ( two [ 1 % ] each ) ; for ICC , these included neutropenia ( 14 [ 14 % ] of 102 ) , thrombocytopenia ( six [ 6 % ] ) , and anaemia ( five [ 5 % ] ) . We noted grade 3 - 4 drug-related serious adverse events in 12 ( 5 % ) nivolumab-treated patients and nine ( 9 % ) patients in the ICC group . No treatment-related deaths occurred . INTERPRETATION Nivolumab led to a greater proportion of patients achieving an objective response and fewer toxic effects than with alternative available chemotherapy regimens for patients with advanced melanoma that has progressed after ipilimumab or ipilimumab and a BRAF inhibitor . Nivolumab represents a new treatment option with clinical ly meaningful durable objective responses in a population of high unmet need . FUNDING Bristol-Myers Squibb BACKGROUND Patients with advanced squamous-cell non-small-cell lung cancer ( NSCLC ) who have disease progression during or after first-line chemotherapy have limited treatment options . This r and omized , open-label , international , phase 3 study evaluated the efficacy and safety of nivolumab , a fully human IgG4 programmed death 1 ( PD-1 ) immune-checkpoint-inhibitor antibody , as compared with docetaxel in this patient population . METHODS We r and omly assigned 272 patients to receive nivolumab , at a dose of 3 mg per kilogram of body weight every 2 weeks , or docetaxel , at a dose of 75 mg per square meter of body-surface area every 3 weeks . The primary end point was overall survival . RESULTS The median overall survival was 9.2 months ( 95 % confidence interval [ CI ] , 7.3 to 13.3 ) with nivolumab versus 6.0 months ( 95 % CI , 5.1 to 7.3 ) with docetaxel . The risk of death was 41 % lower with nivolumab than with docetaxel ( hazard ratio , 0.59 ; 95 % CI , 0.44 to 0.79 ; P<0.001 ) . At 1 year , the overall survival rate was 42 % ( 95 % CI , 34 to 50 ) with nivolumab versus 24 % ( 95 % CI , 17 to 31 ) with docetaxel . The response rate was 20 % with nivolumab versus 9 % with docetaxel ( P=0.008 ) . The median progression-free survival was 3.5 months with nivolumab versus 2.8 months with docetaxel ( hazard ratio for death or disease progression , 0.62 ; 95 % CI , 0.47 to 0.81 ; P<0.001 ) . The expression of the PD-1 lig and ( PD-L1 ) was neither prognostic nor predictive of benefit . Treatment-related adverse events of grade 3 or 4 were reported in 7 % of the patients in the nivolumab group as compared with 55 % of those in the docetaxel group . CONCLUSIONS Among patients with advanced , previously treated squamous-cell NSCLC , overall survival , response rate , and progression-free survival were significantly better with nivolumab than with docetaxel , regardless of PD-L1 expression level . ( Funded by Bristol-Myers Squibb ; CheckMate 017 Clinical Trials.gov number , NCT01642004 . ) BACKGROUND Outcomes are poor for patients with previously 
    Output:
    
Results Nivolumab was not cost-effective over chemotherapy for recurrent/metastatic head/neck cancers ( HNCs ) .
For non-small cell lung cancer ( NSCLC ) , nivolumab was not cost-effective for a general cohort , but increased PD-L1 cutoffs result ed in CE .
Pembrolizumab was cost-effective for both previously treated and newly-diagnosed metastatic NSCLC .
For genitourinary cancers ( GUCs , renal cell and bladder cancers ) , nivolumab and pembrolizumab were not cost-effective options .
Regarding metastatic/unresected melanoma , ipilimumab monotherapy is less cost-effective than nivolumab , nivolumab/ipilimumab , and pembrolizumab .
The addition of ipilimumab to nivolumab monotherapy was not adequately cost-effective .
Pembrolizumab or nivolumab monotherapy offered comparable CE profiles .
Conclusions With limited data and from the reference WTP , nivolumab was not cost-effective for HNCs .
Pembrolizumab was cost-effective for NSCLC ; although not the case for nivolumab , applying PD-L1 cutoffs result ed in adequate CE .
Most data for nivolumab and pembrolizumab in GUCs did not point towards adequate CE .
Contrary to ipilimumab , either nivolumab or pembrolizumab is cost-effective for melanoma .
Despite these conclusions , it can not be overstated that careful patient selection is critical for CE .