A Cost-Effectiveness Analysis: First-Line Avelumab Plus Axitinib Versus Sunitinib for Advanced Renal-Cell Carcinoma

Lu, Peiyao; Liang, Weiting; Li, Jiahao; Hong, Yanming; Chen, Zhuojia; Liu, Tao; Dong, Pei; Huang, Hongbing; Zhang, Tiantian; Jiang, Jie

doi:10.3389/fphar.2020.00619

Cited by 18 publications

(13 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The unit prices of pembrolizumab, nivolumab, ipilimumab, and avelumab in the United States were estimated based on the 2021 average sale price from the Centers for Medicare and Medicaid Services (CMS) ( CMS, 2021 ). The costs of the oral drugs, including lenvatinib, axitinib, sunitinib, cabozantinib, and sorafenib, were derived from public databases and the literature ( CMS, 2021 ; Su et al, 2021 ; Lu et al, 2020 ). Although the mean patient weight in the United States is 74.7 kg, the price of medications was estimated using a patient weight of 70 kg, accounting for weight loss effects in disease ( Wan et al, 2019 ; Lu et al, 2020 ).…”

Section: Methodsmentioning

confidence: 99%

“…The costs of the oral drugs, including lenvatinib, axitinib, sunitinib, cabozantinib, and sorafenib, were derived from public databases and the literature ( CMS, 2021 ; Su et al, 2021 ; Lu et al, 2020 ). Although the mean patient weight in the United States is 74.7 kg, the price of medications was estimated using a patient weight of 70 kg, accounting for weight loss effects in disease ( Wan et al, 2019 ; Lu et al, 2020 ). The administration fee was based on the 2021 CMS Physician Fee Schedule, with the duration of drug infusion based on RCTs and United States Food and Drug Administration package inserts ( Centers for Medicare & Medicaid Services, 2021 ).…”

Section: Methodsmentioning

confidence: 99%

“…The administration fee was based on the 2021 CMS Physician Fee Schedule, with the duration of drug infusion based on RCTs and United States Food and Drug Administration package inserts ( Centers for Medicare & Medicaid Services, 2021 ). The overall costs associated with the management of grade 3 or 4 AEs and BSC were obtained from previous literature ( Perrin et al, 2015 ; Swallow et al, 2018 ; Wan et al, 2019 ; Bensimon et al, 2020 ; Lu et al, 2020 ; Watson et al, 2020 ; Agency for Healthcare Research and Quality, US Dept of Health and Human Services (2021) ).…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Cost-Effectiveness of Frontline Treatment for Advanced Renal Cell Carcinoma in the Era of Immunotherapies

Peng

et al. 2021

Front. Pharmacol.

View full text Add to dashboard Cite

Background: Recent randomized controlled trials have demonstrated that immune checkpoint inhibitors (ICIs) improve patient outcomes, but whether these novel agents are cost-effective for untreated advanced renal cell carcinoma (aRCC) remains unclear.Materials and Methods: A microsimulation model was created to project the healthcare costs and outcomes of six strategies (lenvatinib-plus-pembrolizumab, nivolumab-plus-cabozantinib, nivolumab-plus-ipilimumab, pembrolizumab-plus-axitinib, avelumab-plus-axitinib, and sunitinib monotherapy) for patients with aRCC. Transition probability of patients was estimated from CLEAR, CheckMate 9ER, CheckMate 214, KEYNOTE-426, JAVELIN Renal 101, and other data sets by using parametric survival modeling. Lifetime direct medical costs, life years (LYs), quality-adjusted LYs (QALYs), and incremental cost-effectiveness ratios (ICERs) were estimated from a United States payer perspective. One-way and probabilistic sensitivity analyses were performed, along with multiple scenario analyses, to evaluate model uncertainty.Results: Of the six competing strategies, nivolumab-plus-cabozantinib yielded the most significant health outcomes, and the sunitinib strategy was the least expensive option. The cost-effective frontier consisted of the nivolumab-plus-cabozantinib, pembrolizumab-plus-axitinib, and sunitinib strategies, which displayed the ordered ICERs of $81282/QALY for pembrolizumab-plus-axitinib vs sunitinib and $453391/QALY for nivolumab-plus-cabozantinib vs pembrolizumab-plus-axitinib. The rest of the strategies, such as lenvatinib-plus-pembrolizumab, nivolumab-plus-ipilimumab, and avelumab-plus-axitinib, were dominated. The cost of sunitinib drove the model most influentially.Conclusions: For aRCC, the pembrolizumab-plus-axitinib strategy is likely to be the most cost-effective alternative at the willingness-to-pay threshold of $100,000.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Cost-Effectiveness of Frontline Treatment for Advanced Renal Cell Carcinoma in the Era of Immunotherapies

Peng

et al. 2021

Front. Pharmacol.

View full text Add to dashboard Cite

show abstract

“…The costs of oral drugs (sunitinib, cabozantinib, axitinib, and sorafenib) not included in CMS were collected from public literature and databases. ( ASP Drug Pricing Files, 2021 ; Su et al, 2021 ; Lu et al, 2020 ; Watson et al, 2020 ). Medication costs were estimated using a baseline patient with a weight of 70 kg since weight loss effects in disease were considered ( Wan et al, 2019 ; Lu et al, 2020 ).…”

Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness of Nivolumab Plus Cabozantinib Versus Sunitinib as a First-Line Treatment for Advanced Renal Cell Carcinoma in the United States

Peng

et al. 2021

Front. Pharmacol.

View full text Add to dashboard Cite

Background: In a recent randomized, phase 3 trial (CheckMate 9ER), nivolumab combined with cabozantinib significantly improved patient outcomes compared with sunitinib. However, the cost-effectiveness of these novel agents for untreated advanced renal cell carcinoma (aRCC) remains unknown.Materials and Methods: We constructed a microsimulation decision-analytic model to measure the healthcare costs and outcomes of nivolumab plus cabozantinib compared with those of sunitinib for patients with aRCC. The transition probability of patients was calculated from CheckMate 9ER using parametric survival modeling. Lifetime direct medical costs, life years (LYs), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were estimated for nivolumab-plus-cabozantinib treatment compared with sunitinib from a US payer perspective. We conducted one-way and probabilistic sensitivity analyses and a series of scenario analyses to evaluate model uncertainty.Results: Nivolumab plus cabozantinib was associated with an improvement of 0.59 LYs and 0.56 QALYs compared with sunitinib. However, incorporating nivolumab plus cabozantinib into first-line treatment was associated with significantly higher lifetime costs ($483,352.70 vs. $198,320.10), causing the incremental cost-effectiveness ratio for nivolumab plus cabozantinib to be $508,987/QALY. The patients’ age of treatment, first-line utility, and cost of nivolumab had the greatest influence on the model. The outcomes were robust when tested in sensitivity and scenario analyses.Conclusion: For aRCC, substituting nivolumab plus cabozantinib in the first-line setting is unlikely to be cost-effective under the current willingness-to-pay threshold ($150,000/QALY). Significant price decreases for nivolumab used in first-line therapy would be needed to drop ICERs to a more diffusely acceptable value.

show abstract

“…The authors chose to utilize a partitioned survival model (PSM), rather than a Markov or semi-Markov state-transition model (STM). Previous cost-effectiveness studies for advanced RCC therapy have varied in use of PSM versus STM [12,13]. A study by Smare et al, evaluated STM versus PSM in cost-effectiveness in RCC using the competing drug nivolumab as a standalone treatment compared everolimus in patients with previously treated advanced RCC and concluded that different model structures may produce different estimates of QALY that alter cost-effectives conclusions.…”

mentioning

confidence: 99%

Cost-effectiveness of first-line treatments in metastatic renal cell carcinoma

Benton

Klaassen

Wallis

2021

Current Medical Research and Opinion

View full text Add to dashboard Cite

A Cost-Effectiveness Analysis: First-Line Avelumab Plus Axitinib Versus Sunitinib for Advanced Renal-Cell Carcinoma

Cited by 18 publications

References 27 publications

Cost-Effectiveness of Frontline Treatment for Advanced Renal Cell Carcinoma in the Era of Immunotherapies

Cost-Effectiveness of Frontline Treatment for Advanced Renal Cell Carcinoma in the Era of Immunotherapies

Cost-Effectiveness of Nivolumab Plus Cabozantinib Versus Sunitinib as a First-Line Treatment for Advanced Renal Cell Carcinoma in the United States

Cost-effectiveness of first-line treatments in metastatic renal cell carcinoma

Contact Info

Product

Resources

About