The Additional Costs per Month of Progression-Free Survival and Overall Survival: An Economic Model Comparing Everolimus with Cabozantinib, Nivolumab, and Axitinib for Second-Line Treatment of Metastatic Renal Cell Carcinoma

Abstract

Funding for this research was provided by Novartis, which was involved in all stages of study research and manuscript preparation. Ghate and Perez are employees of Novartis and own stock/stock options. Swallow, Messali, McDonald, and Duchesneau are employees of Analysis Group, which has received consultancy fees from Novartis. Study concept and design were contributed by Swallow, Messali, Ghate, and Perez, along with McDonald and Duchesneau. Swallow, Messali, McDonald, and Duchesneau collected the data, and all authors participated in data interpretation. The manuscript was written by Swallow, Messali, and Ghate, along with the other authors, and revised by Swallow, Messali, Ghate, and Perez. A synopsis of the current research was presented in poster format at the 15th International Kidney Cancer Symposium on November 4-5, 2016, in Miami, Florida.

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

“…[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.…”

“…[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.…”

“…[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.…”

Cabozantinib for the Management of Metastatic Clear Cell Renal Cell Carcinoma

“…A recent systematic review which evaluated the cost-effectiveness of cabozantinib compared with other second-line therapies found that although cabozantinib was associated with favourable progression-free and overall survival, it was also one of the most expensive drugs (compared with everolimus, axitinib, nivolumab and sunitinib). In US dollars, costs of cabozantinib per patient per month of progression-free and overall survival were $17,864 and $11,166–$12,303, compared with $16,889 and $8,569–$9,724 with everolimus ( 32 ).…”