Cost-effectiveness of Atezolizumab Plus Bevacizumab vs Sorafenib as First-Line Treatment of Unresectable Hepatocellular Carcinoma

Su, Dan; Wu, Bin; Shi, Lizheng

doi:10.1001/jamanetworkopen.2021.0037

Cited by 120 publications

(100 citation statements)

References 25 publications

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“…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%

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

Peng

et al. 2021

Front. Pharmacol.

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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.

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Section: Methodsmentioning

confidence: 99%

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

Peng

et al. 2021

Front. Pharmacol.

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“…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.

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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.

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“…To perform the PSA, a second-order Monte Carlo simulation was used to analyze the results through 1,000 random sampling, while the variables varied with a specific distribution pattern (18). Combining parameter constraints and statistical distribution characteristics, we assumed that Gamma distribution was selected for the cost parameters, and the Beta distribution was selected for the utility parameters (19). The PSA was represented by the incremental cost-effectiveness scatter plot and costeffectiveness acceptable curve to verify the uncertainty of the results.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of camrelizumab versus chemotherapy for the treatment of advanced or metastatic esophageal squamous cell carcinoma

Li¹,

Liu²,

Huang³

et al. 2022

J Gastrointest Oncol

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Background: To evaluate the cost-effectiveness of camrelizumab versus chemotherapy for patients with advanced or metastatic esophageal squamous cell carcinoma (ESCC) from the perspective of health system and to provide a basis for health decisions in China.Methods: A Markov model of 3 health states throughout the lifetime was established based on data from the ESCORT trial. Life-years, quality-adjusted life-years (QALYs), and lifetime costs were estimated. The time horizon of lifetime was 5 years and each model cycle represented 2 months. The cost and utility value adopted a 5% discount rate per year. One-way sensitivity analysis and probability sensitivity analysis were used to test the robustness of the results. Results:The results of the cost-effectiveness analysis revealed that the camrelizumab group produced a gain of 2.93 QALY, at a cost of $37,809.12 USD, and the chemotherapy group gained 2.85 QALY, at a cost of $3,7071.52 USD. Camrelizumab was more cost-effective than chemotherapy for patients with advanced or metastatic ESCC. The results of one-way sensitivity analyses showed that the cost of camrelizumab, cost of chemotherapy and utility of progression-free survival (PFS) state were the top three parameters influencing the model. The probability sensitivity analysis results showed that the results of the basic case analysis were stable.Conclusions: Under the willingness to pay threshold of three times per capita GDP of China, camrelizumab as second-line treatment could provide more health benefits for advanced or metastatic ESCC in China.

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Cost-effectiveness of Atezolizumab Plus Bevacizumab vs Sorafenib as First-Line Treatment of Unresectable Hepatocellular Carcinoma

Cited by 120 publications

References 25 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 camrelizumab versus chemotherapy for the treatment of advanced or metastatic esophageal squamous cell carcinoma

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