155eP Real-world effectiveness of first-line nivolumab plus ipilimumab with chemotherapy in patients with non-small cell lung cancer with low PD-L1 tumor expression (Dutch NVALT-34 study)

applied published incremental QALY/DALY estimates and ICERs from KEYNOTE-024/ 189 cost-utility models to generate indirect cohort-level value estimates under trialequivalent and effectiveness-adjusted scenarios.Results: Among 183 treated patients, 175/183 were evaluable, with a median followup of 16.5 months.Median age was 70.3 years.Forty-nine patients received pembrolizumab monotherapy: median OS was 10.6 months, and 12-/24-/36-month OS rates were 46.7%/42.4%/38.2%;median TTD was 5.1 months.One hundred twentysix patients received pembrolizumab plus chemotherapy: median OS was 10.4 months, and 12-/24-/36-month OS rates were 45.7%/27.6%/8.5%;median TTD was 3.7 months.Crosswalking published cost-utility results (QALY 1.05 for monotherapy; 1.70 for chemoimmunotherapy; ICERs 91k-97k/QALY) suggested a projected cohort gain of 265 QALYs (trial-equivalent) and 120 QALYs after effectiveness adjustment, implying a comparable magnitude of DALYs averted. Conclusions:In this monocentric real-world experience, pembrolizumab-based firstline strategies yielded clinically meaningful survival.Indirect QALY/DALY and ICER crosswalk supports the concept that, despite high upfront costs, immunotherapy in metastatic NSCLC may generate substantial long-term value through sustained gains in both quality and length of life.