Cost-effectiveness of nivolumab in patients with advanced renal cell carcinoma treated in the United States

Abstract

BackgroundWe evaluated the cost-effectiveness of nivolumab versus everolimus in patients with advanced renal cell carcinoma (RCC) from a US payer perspective.MethodsA partitioned survival model consisting of three health states, progression-free survival (PFS), progressive disease, and death, was developed to evaluate the cost-effectiveness of intravenous nivolumab versus oral everolimus over a lifetime. The proportion of patients in each state was calculated based on parametric distributions fitted to PFS and overall survival (OS) data from CheckMate 025 (N = 821), a large randomized phase 3 trial of nivolumab versus everolimus for advanced RCC. Health state utility data were derived from CheckMate 025 EQ-5D data. Scenario analyses and deterministic and probabilistic sensitivity analyses assessed the impact of uncertainty in model inputs on outcomes.ResultsOver a 25-year lifetime horizon, treatment with nivolumab resulted in a gain of 0.64 quality-adjusted life-years (QALYs) versus everolimus. Nivolumab had greater total costs versus everolimus ($US197,089 vs. $US163,902), mainly due to higher acquisition costs. The incremental cost-utility ratio (ICUR), a measure of incremental costs divided by incremental QALYs, was $US51,714 per QALY gained for nivolumab versus everolimus, and an incremental cost-effectiveness ratio was $US44,576 per life-year gained for nivolumab versus everolimus. In sensitivity analyses, average body weight had the greatest impact on the ICUR for nivolumab versus everolimus (base case $US51,714; range $US8863–$US94,566). At a $US150,000 willingness-to-pay (WTP) threshold, nivolumab had a 91.7% probability of being cost-effective versus everolimus.ConclusionsIn the United States, at a WTP threshold of $US150,000 per QALY, nivolumab was found to be cost-effective. Key drivers of cost-effectiveness were survival inputs for OS and the average weight of patients; the latter directly affects nivolumab drug acquisition cost.Electronic supplementary materialThe online version of this article (10.1186/s40164-018-0095-8) contains supplementary material, which is available to authorized users.

Cost-effectiveness of nivolumab plus ipilimumab as first-line therapy in advanced renal-cell carcinoma

“…The results of one-way sensitivity analysis found that body weight had the greatest impact on the model outcome. One recent study that evaluated the cost-effectiveness of nivolumab versus everolimus in patients with advanced RCC in the US also found that average body weight had the greatest impact on the ICER for nivolumab versus everolimus (base case US $51,714; range US $8863–$94,566) [ 24 ]. The potential reason for this is that the dosage of sunitinib treatment is administered regardless of body weight, and the dosage of nivolumab and ipilimumab need to be adjusted according to the body weight.…”

“…Nivolumab and ipilimumab were administered intravenously at a dose of 3 mg/kg and 1 mg/kg, respectively, every 3 weeks for four doses (induction phase), followed by nivolumab monotherapy at a dose of 3 mg/kg every 2 weeks (maintenance phase). To calculate the dosage of nivolumab and ipilimumab agents, we assumed a typical patient weighed 71.4 kg in the US, 78.7 kg in the UK and 59 kg in China, and the range (29–112 kg) was used in the sensitivity analysis [ 16 , 24 , 25 ]. Based on previous reports, the maximum treatment duration of nivolumab plus ipilimumab was two years [ 16 , 26 ].…”

“…The Chinese price of nivolumab is $1362/100 mg. Because ipilimumab are still unavailable in the Chinese market, we estimate its price by multiplying the price of ipilimumab in UK and the ratio of the price of nivolumab between UK and China. Other cost data were collected from published literature [ 19 , 21 , 23 , 24 , 26 , 28 – 35 ].…”

“…Mean health utility scores for PFS and PD state were derived from published literature (Table 1 ) [ 24 , 29 , 41 , 42 ]. The disutility values due to grade 1/2 and 3/4 AE were included in this analysis [ 41 ].…”

Cost‐effectiveness analysis of pembrolizumab plus chemotherapy with PD‐L1 test for the first‐line treatment of NSCLC

“…16,[19][20][21][22][23][28][29][30][31][32] For dosage calculation in the United States and China, body surface area (BSA) and body weight of 1.84 m 2 , 71.4 kg and 1.72 m 2 , 65 kg were adopted respectively. [33][34][35]…”