Nivolumab Is a Cost-Effective Second-Line Treatment for Metastatic Renal-Cell Carcinoma

Economic Burden of Renal Cell Carcinoma—Part I: An Updated Review

“…Fourteen cost-effectiveness studies focused on the 2nd-line treatment of mRCC, and assessed the following drugs: sorafenib, everolimus, temsirolimus, sunitinib, nivolumab, cabozantinib, and axitinib. Seven studies also included best supportive care (BSC) as a comparator; [25][26][27][28][29][30][31] Of the four studies, all published prior to 2015, that modeled BSC as the "standard of care" none concluded BSC was dominated by the new therapy that it was compared against. [25][26][27][28] Two studies that compared sorafenib vs. BSC, both conducted in Cyprus, concluded that the cost-effectiveness of sorafenib largely depended on the drug price.…”

“…[28] As more new drugs were approved for second-line therapy of mRCC, BSC became less common in second-line settings and cost-effectiveness analyses were able to model clinical parameters from head-to-head trials, such as the AXIS (AXItinib vs. Sorafenib in advanced renal cell carcinoma) trial for axitinib vs. sorafenib [32] and the CheckMate 025 trial for nivolumab vs. everolimus. [33] Eight studies included both nivolumab and everolimus in the comparators [29][30][31][34][35][36][37][38] and these two drugs were directly compared in six. [29,31,[34][35][36]38].…”

“…[33] Eight studies included both nivolumab and everolimus in the comparators [29][30][31][34][35][36][37][38] and these two drugs were directly compared in six. [29,31,[34][35][36]38]. Only two out of the six studies found nivolumab to be cost effective compared to everolimus.…”

“…Only two out of the six studies found nivolumab to be cost effective compared to everolimus. Specifically, Giuliani and colleagues reported an ICER around $2,400 per month of life gained for nivolumab compared to everolimus [29] and McCrea and colleagues estimated the ICER to be close to $52,000 per quality-adjusted life year (QALY) gained. [35] The other four studies concluded that nivolumab was unlikely to be more cost effective than everolimus when benchmarking against the societal willingness to pay (WTP) of $100,000/ QALY.…”

“…[31,34,36,38] It is worth noting that the study by Giuliani et al may reflect a partial assessment because their analyses only considered drug cost. [29] Comparisons between cabozantinib and everolimus were identified in three studies; all three reported ICER higher than $150,000 per QALY or LY when cabozantinib was compared to everolimus. [30,37,38] Collectively, the literature to date is leaning toward less favorable cost-effectiveness conclusions for newly approved agents for second-line treatment of mRCC, such as cabozantinib and nivolumab, when compared to everolimus.…”