Cost-Effectiveness of Nivolumab Plus Ipilimumab for the First-Line Treatment of Intermediate/Poor-Risk Advanced and/or Metastatic Renal Cell Carcinoma in Switzerland

Abstract

Objective This study assessed the cost-effectiveness of nivolumab plus ipilimumab versus both sunitinib and pazopanib for the treatment of first-line unresectable advanced renal cell carcinoma (aRCC) from a healthcare system perspective in Switzerland. Methods A three-state partitioned survival model, consisting of progression-free, progressed disease, and death, was constructed. Efficacy estimates were based on data from the CheckMate 214 trial (NCT02231749) with a minimum follow-up of 42 months. Two Swiss oncologists were consulted to determine disease management resource use. Costs were derived from the Swiss tariff lists for outpatient (TARMED Online Browser 1.09) and inpatient (2020 data from Swiss diagnosis-related groups) treatments. Drug acquisition costs (ex-factory prices) were obtained from the March 2020 price list published by the Swiss Federal Office of Public Health. Treatment-specific EQ-5D-3L-based utilities were derived from CheckMate 214 using a French value set as a proxy for Switzerland. The model utilized a 1-week cycle length and a 40-year time horizon, with costs and effects discounted by 3.0% per annum. One-way sensitivity analyses, probabilistic analysis, and scenario analyses assessed the robustness of the results. Results Nivolumab plus ipilimumab yielded incremental 1.43 life-years and 1.36 lifetime discounted quality-adjusted life-years (QALYs) relative to sunitinib and pazopanib at an additional cost of 147,453 Swiss Francs (CHF) and CHF145,643, respectively. With an incremental cost-utility ratio of CHF108,326 per QALY gained versus sunitinib, and CHF106,996 per QALY gained versus pazopanib, the nivolumab plus ipilimumab combination can be considered a cost-effective option for the treatment of patients with aRCC in Switzerland, with a willingness-to-pay threshold of CHF200,000. Sensitivity and scenario analyses confirmed the robustness of the deterministic results. Conclusions This study showed that nivolumab plus ipilimumab, which represents one of the standard-of-care first-line treatments for intermediate- or poor-risk aRCC patients, is a life-extending and cost-effective treatment option for patients in Switzerland. Supplementary Information The online version contains supplementary material available at 10.1007/s41669-023-00395-1.

Artificial Intelligence to Automate Health Economic Modelling: A Case Study to Evaluate the Potential Application of Large Language Models

“…Both published models were built in Microsoft Excel. One model assessed the costeffectiveness of nivolumab versus docetaxel in patients with non-small cell lung cancer (NSCLC) previously treated with platinum-based chemotherapy from a US payer perspective (the NSCLC model), and the other assessed the cost effectiveness of nivolumab plus ipilimumab versus both sunitinib and pazopanib for the first-line treatment of unresectable advanced renal cell carcinoma (RCC) in Switzerland (the RCC model) [10,11]. Key characteristics of each model are presented in Table 1.…”

Nivolumab and Ipilimumab Acting as Tormentors of Advanced Tumors by Unleashing Immune Cells and Associated Collateral Damage

“…In a randomized controlled trial comparing nivolumab plus ipilimumab with sunitinib in patients with advanced renal cell carcinoma, durable clinical benefits and higher conditional survival rates were observed with nivolumab plus ipilimumab, highlighting its long-term efficacy and potential as a first-line immunotherapy-based combination. In a randomized controlled trial, nivolumab plus ipilimumab exhibited prolonged overall survival and durable responses compared to sunitinib in patients with advanced sarcomatoid renal cell carcinoma, highlighting its efficacy as a preferred first-line therapy [ 75 , 76 , 77 , 78 , 79 , 81 , 82 , 83 , 84 ].…”