Unknown

Dataset Information

0

Cost-effectiveness of Pembrolizumab Plus Axitinib Vs Nivolumab Plus Ipilimumab as First-Line Treatment of Advanced Renal Cell Carcinoma in the US.


ABSTRACT: Importance:Checkpoint inhibitor combination therapy represents a major advance in the first-line treatment of advanced renal cell carcinoma. Pembrolizumab-axitinib and nivolumab-ipilimumab have become standard of care options after demonstrating clinical efficacy against sunitinib in separate phase 3 trials. The cost-effectiveness of these regimens is unknown. Objective:To evaluate the cost-effectiveness of pembrolizumab-axitinib and nivolumab- ipilimumab in the first-line treatment of advanced renal cell carcinoma. Design, Setting, and Participants:For this economic evaluation, a primary microsimulation model was developed and run between August and December 2019. Separate analyses were conducted for an intermediate- and poor-risk patient population (base case) and a favorable-risk population (exploratory analysis) because prognosis is known to differ between risk groups; 100?000 patients with advanced renal cell carcinoma were simulated in each treatment arm. Survival, treatment regimens, and other relevant conditions were based on data from the phase 3 KEYNOTE-426 and CheckMate214 clinical trials. The study perspective was the US health care sector. Main Outcomes and Measures:An incremental cost-effectiveness ratio was calculated for each of the 2 analyses and compared with a willingness-to-pay threshold of $100?000 per quality-adjusted life-year (QALY). Results:Pembrolizumab-axitinib was estimated to add 0.60 QALYs compared with nivolumab-ipilimumab in the base case analysis (3.66 vs 3.05 QALYs) and 0.25 QALYs compared with nivolumab-ipilimumab in the exploratory analysis (4.55 vs 4.30 QALYs), and was more costly (base case analysis: $562?927 vs $458?961; exploratory analysis: $589?035 vs $470?403). The incremental cost-effectiveness ratio was $172?532 per QALY in the base case analysis and $468?682 per QALY in the exploratory analysis. One-way sensitivity analyses revealed that the base case model was most sensitive to first-line drug prices (incremental cost-effectiveness ratio at upper limit of nivolumab price and lower limits of axitinib and pembrolizumab prices: $89?983, $102?287, and $114?943 per QALY, respectively). The exploratory analysis model was most sensitive to overall survival rates (incremental cost-effectiveness ratio at lower limit of pembrolizumab-axitinib rate and upper limit of nivolumab-ipilimumab rate: $278?644 and $285?684 per QALY, respectively). Conclusions and Relevance:The findings suggest that pembrolizumab-axitinib treatment is associated with greater QALYs compared with nivolumab/ipilimumab treatment in patients with advanced renal cell carcinoma but may not be cost-effective. Price reductions may make the cost of pembrolizumab-axitinib proportional to its clinical value and less financially burdensome to the US health care system.

SUBMITTER: Watson TR 

PROVIDER: S-EPMC7557509 | BioStudies | 2020-01-01

REPOSITORIES: biostudies

Similar Datasets

2020-01-01 | S-EPMC7436799 | BioStudies
2018-01-01 | S-EPMC6247499 | BioStudies
2020-01-01 | S-EPMC7507990 | BioStudies
2019-01-01 | S-EPMC6710483 | BioStudies
2019-01-01 | S-EPMC6924863 | BioStudies
2018-01-01 | S-EPMC5922245 | BioStudies
2020-01-01 | S-EPMC7311503 | BioStudies
2018-01-01 | S-EPMC6251215 | BioStudies
2019-01-01 | S-EPMC6764123 | BioStudies
1000-01-01 | S-EPMC5810189 | BioStudies