Economic evaluation of first-line nivolumab plus cabozantinib for advanced renal cell carcinoma in China

Abstract

BackgroundIn the Checkmate9ER trial, first-line treatment with nivolumab combined with cabozantinib (NI + CA) has shown efficacy for advanced renal cell carcinoma. This study aims to evaluate the impact of the health and economic outcomes of NI + CA in China.MethodsClinical efficacy data were derived from pivotal phase III CheckMate 9ER trial. A three-state partitioned survival model was established based on disease progression. Progression-free survival and overall survival of NI + CA vs. sunitinib were fitted with log-logistic and log-normal distributions, respectively. Mixture cure, non-mixture cure, and Royston/Parmar spline models were used to evaluate model robustness. The results derived the computational cost from the Chinese healthcare system perspective. The primary outcomes were quality-adjusted life-years (QALYs), total cost in US dollars, as well as incremental cost-effectiveness ratios (ICERs) at the willingness-to-pay threshold in China. One-way and probabilistic sensitivity analysis were also used to assess the robustness of the model.ResultsIn the base-case analysis result, 0.86 additional QALYs could be obtained in the NI+CA (3.84 QALYs) versus the sunitinib strategy (2.97 QALYs). The ICER of NI+CA compared with the sunitinib strategy was US$292,945 per QALY. The ICER value in the NI+CA strategy was higher than the Chinese willingness-to-pay threshold of US$38,024 per QALY. Although NI+CA can improve long-term patient survival significantly over sunitinib in the treatment of advanced renal cell carcinoma, it is unlikely to be cost-effective due to high cost. The results of the one-way sensitivity analysis showed that drug cost, health utility value at the stage of disease progression, and subsequent treatment proportion had a greater impact on the stability of ICER values.ConclusionsNivolumab combined with cabozantinib can prolong the life of patients with advanced renal cell carcinoma and improve their quality of life, but there is a corresponding increase in medical cost. The NI + CA strategy is unlikely to be considered cost-effective in the treatment of advanced RCC from the perspective of Chinese healthcare system.

Real‐world data on efficacy/safety and economic impact of nivolumab administered every 2 and 4 weeks among Japanese patients

“…15 Wang et al reported that combination therapy with nivolumab and tyrosine kinase inhibitors may increase medical costs and could be less cost-effective in patients with renal cell carcinoma. 27 In patients with melanoma who were administered adjuvant treatment, nivolumab may be more cost-effective than other immune checkpoint inhibitors and molecule-targeted therapies. 22 Furthermore, Kashiwa et al revealed that nivolumab was more cost-effective as a late-line treatment than as a first-line treatment for gastric cancer.…”

“…Given that ∼90% of medical costs are attributed to medical consultation fees and drugs, especially in the field of oncology, where treatment costs are becoming increasingly expensive, economic evaluation is crucial. The economic impact of nivolumab has been reported for melanoma, lung cancer, gastric cancer, and renal cell carcinoma 18,22–27 . Wang et al.…”

Reactualization of sunitinib in the treatment of metastatic renal cell carcinoma

“…Следует учитывать и то, что группа благоприятного прогноза мПКР неоднородна по молекулярно-генетическому профилю, и персонализированный подход позволяет выделить пациентов, для которых монотерапия сунитинибом является оптимальным вариантом лечения [25]. Зачастую монотерапия сунитинибом обладает меньшей финансовой нагрузкой и более доступна в клинической практике [32][33][34], а также оставляет больше вариантов для последующих линий терапии 2 .…”