A cost-effectiveness analysis of Nivolumab and Ipilimumab versus Sunitinib in first line intermediate-poor risk advanced Renal Cell Carcinoma

Reinhorn, Daniel; Sarfaty, Michal; Neiman, Victoria; Rosenbaum, Evan; Goldstein, David

doi:10.1016/s1569-9056(18)33792-8

Cited by 9 publications

(15 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our findings are comparable with the recently published economic evaluations in the USA [37][38][39] that compared nivolumab + ipilimumab using cohort-based models. One of the US analyses, Wan et al, compared nivolumab + ipilimumab and sunitinib in first-line setting over lifetime horizon [37].…”

Section: Discussionsupporting

confidence: 89%

Clinical and Economic Outcomes of Treatment Sequences for Intermediate- to Poor-Risk Advanced Renal Cell Carcinoma

et al. 2020

View full text Add to dashboard Cite

Aim: To assess the cost–effectiveness of treatment sequences for patients with intermediate- to poor-risk advanced renal cell carcinoma. Patients & methods: A discrete event simulation model was developed to estimate patients’ lifetime costs and survival. Efficacy inputs were derived from the CheckMate 214 and CheckMate 025 studies and network meta-analyses. Safety and cost data were obtained from the published literature. Results: The estimated average quality-adjusted life-years (QALYs) gained was the highest on nivolumab + ipilimumab-initiated sequences (3.6–5.3 QALYs) versus tyrosine kinase inhibitor (TKI)-initiated sequences (2.1–3.7 QALYs). Incremental cost per QALY gained for nivolumab + ipilimumab-initiated sequences was below the willingness-to-pay threshold of $150,000 versus other sequences. Conclusion: Immuno-oncology combination therapy followed by TKIs is cost-effective versus TKI sequences followed by immuno-oncology or sequencing TKIs.

show abstract

Section: Discussionsupporting

confidence: 89%

Clinical and Economic Outcomes of Treatment Sequences for Intermediate- to Poor-Risk Advanced Renal Cell Carcinoma

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Previous studies have estimated nivolumab-ipilimumab to be cost-effective for intermediate- and poor-risk patients compared with sunitinib. 25 , 38 , 39 Our choice not to model sunitinib represents an effort to reflect the recent shift in the RCC treatment paradigm away from sunitinib as the standard first-line therapy and toward checkpoint inhibitor combinations.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of Pembrolizumab Plus Axitinib Vs Nivolumab Plus Ipilimumab as First-Line Treatment of Advanced Renal Cell Carcinoma in the US

et al. 2020

View full text Add to dashboard Cite

IMPORTANCE Checkpoint inhibitor combination therapy represents a major advance in the first-line treatment of advanced renal cell carcinoma. Pembrolizumab-axitinib and nivolumab-ipilimumab have become standard of care options after demonstrating clinical efficacy against sunitinib in separate phase 3 trials. The cost-effectiveness of these regimens is unknown. OBJECTIVE To evaluate the cost-effectiveness of pembrolizumab-axitinib and nivolumabipilimumab in the first-line treatment of advanced renal cell carcinoma. DESIGN, SETTING, AND PARTICIPANTS For this economic evaluation, a primary microsimulation model was developed and run between August and December 2019. Separate analyses were conducted for an intermediate-and poor-risk patient population (base case) and a favorable-risk population (exploratory analysis) because prognosis is known to differ between risk groups; 100 000 patients with advanced renal cell carcinoma were simulated in each treatment arm. Survival, treatment regimens, and other relevant conditions were based on data from the phase 3 KEYNOTE-426 and CheckMate214 clinical trials. The study perspective was the US health care sector.

show abstract

“…The treatment landscape for mRCC has transformed and will continue to do so rapidly given the ongoing trials for first-line treatment and the integration of immune checkpoint inhibitors [14]. The IMDC risk group classification is relevant for clinicians, as treatments are often approved for patients in a particular risk group [15,16]. For patients classified as intermediate or poor risk, nivolumab plus ipilimumab was approved for first-line treatment.…”

Section: Discussionmentioning

confidence: 99%

Real-World Assessment of Clinical Outcomes Among First-Line Sunitinib Patients with Clear Cell Metastatic Renal Cell Carcinoma (mRCC) by the International mRCC Database Consortium Risk Group

et al. 2020

View full text Add to dashboard Cite

Background. International Metastatic Renal Cell Carcinoma (mRCC) Database Consortium (IMDC) risk groups are important when considering therapeutic options for first-line treatment. Materials and Methods. Adult patients with clear cell mRCC initiating first-line sunitinib between 2010 and 2018 were included in this retrospective database study. Median time to treatment discontinuation (TTD) and overall survival (OS) were estimated using Kaplan-Meier analysis. Outcomes were stratified by IMDC risk groups and evaluated for those in the combined intermediate and poor risk group and separately for those in the intermediate risk group with one versus two risk factors. Results. Among 1,769 patients treated with first-line sunitinib, 318 (18%) had favorable, 1,031 (58%) had intermediate, and 420 (24%) had poor IMDC risk. Across the three risk groups, patients had similar age, gender, and sunitinib initiation year. Median TTD was 15.0, 8.5, and 4.2 months in the favorable, intermediate, and poor risk groups, respectively, and 7.1 months in the combined intermediate and poor risk group. Median OS was 52.1, 31.5, and 9.8 months in the favorable, intermediate, and poor risk groups, respectively, and 23.2 months in the combined intermediate and poor risk group. Median OS (35.1 vs. 21.9 months) and TTD (10.3 vs. 6.6 months) were significantly different between intermediate risk patients with one versus two risk factors. Conclusion. This real-world study found a median OS of 52 months for patients with favorable IMDC risk treated with first-line sunitinib, setting a new benchmark on clinical outcomes of clear cell mRCC. Analysis of intermediate risk group by one or two risk factors demonstrated distinct clinical outcomes. The Oncologist 2020;25:422-430Implications for Practice: This analysis offers a contemporary benchmark for overall survival (median, 52.1 months; 95% confidence interval, 43.4-61.2) among patients with clear cell metastatic renal cell carcinoma who were treated with sunitinib as first-line therapy in a real-world setting and classified as favorable risk according to International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk group classification. This study demonstrates that clinical outcomes differ between IMDC risk groups as well as within the intermediate risk group based on the number of risk factors, thus warranting further consideration of risk group when counseling patients about therapeutic options and designing clinical trials.

show abstract

A cost-effectiveness analysis of Nivolumab and Ipilimumab versus Sunitinib in first line intermediate-poor risk advanced Renal Cell Carcinoma

Cited by 9 publications

References 0 publications

Clinical and Economic Outcomes of Treatment Sequences for Intermediate- to Poor-Risk Advanced Renal Cell Carcinoma

Clinical and Economic Outcomes of Treatment Sequences for Intermediate- to Poor-Risk Advanced Renal Cell Carcinoma

Cost-effectiveness of Pembrolizumab Plus Axitinib Vs Nivolumab Plus Ipilimumab as First-Line Treatment of Advanced Renal Cell Carcinoma in the US

Real-World Assessment of Clinical Outcomes Among First-Line Sunitinib Patients with Clear Cell Metastatic Renal Cell Carcinoma (mRCC) by the International mRCC Database Consortium Risk Group

Contact Info

Product

Resources

About