A health-economics analysis found that nivolumab plus ipilimumab may deliver more quality-adjusted life years at lower total cost than pembrolizumab for metastatic MSI-high or mismatch repair–deficient colorectal cancer. The study frames the comparison around real-world cost-effectiveness rather than only clinical outcomes. Published as an economic study, the analysis adds another decision layer for payers and formularies that are already managing budget pressure alongside expanding immunotherapy indications. In parallel with clinical literature, the findings suggest that regimen choice could shift depending on willingness-to-pay thresholds and local pricing—especially where multiple immune-checkpoint approaches compete for first-line use. For market stakeholders, the key signal is that economic performance may favor dual checkpoint strategies in MSI-H colorectal, potentially influencing prescribing and procurement conversations.