Cost Effectiveness of Nivolumab in Advanced Renal Cell Carcinoma

Sarfaty, Michal; Leshno, Moshe; Gordon, Noa; Moore, Assaf; Neiman, Victoria; Rosenbaum, Eli; Goldstein, Daniel A.

doi:10.1016/j.eururo.2017.07.041

Cited by 60 publications

(41 citation statements)

References 24 publications

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“…In the sensitivity analyses, we used a range for certain values to account for possible inaccuracies, as described above. The use of the AE10% boundary for the utility sensitivity analysis may not reflect the true uncertainty but nevertheless is used as an acceptable boundary in similar studies [14]. One limitation of this model is that An important issue in cost-effective analysis is selecting the appropriate standard of care for the comparator arm in the model.…”

Section: Discussionmentioning

confidence: 99%

A Cost-Effectiveness Analysis of Nivolumab and Ipilimumab Versus Sunitinib in First-Line Intermediate- to Poor-Risk Advanced Renal Cell Carcinoma

et al. 2019

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Background The treatment paradigm of advanced renal cell carcinoma (RCC) has changed rapidly in recent years. In first‐line treatment of intermediate‐ to poor‐risk patients, the CheckMate 214 study demonstrated a significant survival advantage for nivolumab and ipilimumab versus sunitinib. The high cost of combined immune‐modulating agents warrants an understanding of the combination's value by considering both efficacy and cost. The objective of this study was to estimate the cost‐effectiveness of nivolumab and ipilimumab compared with sunitinib for first‐line treatment of intermediate‐ to poor‐risk advanced RCC from the U.S. payer perspective. Materials and Methods A Markov model was developed to compare the costs and effectiveness of nivolumab and ipilimumab with those of sunitinib in the first‐line treatment of intermediate‐ to poor‐risk advanced RCC. Health outcomes were measured in life‐years and quality‐adjusted life‐years (QALYs). Drug costs were based on Medicare reimbursement rates in 2017. We extrapolated survival beyond the trial closure using Weibull distribution. Model robustness was addressed in univariable and probabilistic sensitivity analyses. Results The total mean cost per‐patient of nivolumab and ipilimumab versus sunitinib was $292,308 and $169,287, respectfully. Nivolumab and ipilimumab generated a gain of 0.978 QALYs over sunitinib. The incremental cost‐effectiveness ratio (ICER) for nivolumab and ipilimumab was $125,739/QALY versus sunitinib. Conclusion Our analysis established that the base case ICER in the model for nivolumab and ipilimumab versus sunitinib is below what some would consider the upper limit of the theoretical willingness‐to‐pay threshold in the U.S. ($150,000/QALY) and is thus estimated to be cost‐effective. Implications for Practice This article assessed the cost‐effectiveness of nivolumab and ipilimumab versus sunitinib for treatment of patients with intermediate‐ to poor‐risk metastatic kidney cancer, from the U.S. payer perspective. It would cost $125,739 to gain 1 quality‐adjusted life‐year with nivolumab and ipilimumab versus sunitinib in these patients.

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Section: Discussionmentioning

confidence: 99%

A Cost-Effectiveness Analysis of Nivolumab and Ipilimumab Versus Sunitinib in First-Line Intermediate- to Poor-Risk Advanced Renal Cell Carcinoma

et al. 2019

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“…16,17 The cost of AEs was derived from previously published studies. 16,17 The cost of AEs was derived from previously published studies.…”

Section: Cost and Utility Estimatesmentioning

confidence: 99%

“…The 2018 average sale price from the Centers for Medicare and Medicaid Services plus 4.2% was used to estimate drug costs. 16,17 The cost of AEs was derived from previously published studies. 18,19 Administration costs were estimated according to the Medicare physician fee schedule for 2018.…”

Section: Cost and Utility Estimatesmentioning

confidence: 99%

First‐line atezolizumab in addition to bevacizumab plus chemotherapy for metastatic, nonsquamous non–small cell lung cancer: A United States–based cost‐effectiveness analysis

Wan

Luo

Tan

et al. 2019

Cancer

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BACKGROUND:The IMpower150 trial found that adding atezolizumab to the combination of bevacizumab and chemotherapy improved survival for patients with metastatic, nonsquamous non-small cell lung cancer (NSCLC). However, considering the high cost of immunotherapy, there is a need to assess its value by considering both efficacy and cost. The current study evaluated the cost-effectiveness of atezolizumab in the first-line setting for the treatment of patients with metastatic NSCLC from the US payer perspective. METHODS: A Markov model was developed to compare the lifetime cost and effectiveness of the combination of atezolizumab, bevacizumab, carboplatin, and paclitaxel (ABCP) with the combination of bevacizumab, carboplatin, and paclitaxel (BCP) and carboplatin and paclitaxel (CP) in the first-line treatment of patients with metastatic NSCLC. Life-years (LYs), qualityadjusted LYs (QALYs), and lifetime costs were estimated. One-way and probabilistic sensitivity analyses were performed to evaluate the model uncertainty. Additional subgroup analyses were performed. RESULTS: ABCP provided an additional 0.413 QALYs (0.460 LYs) and 0.738 QALYs (0.956 LYs), respectively, compared with BCP and CP. The corresponding incremental costs were $234,998 and $381,116, respectively. The incremental cost-effectiveness ratio for ABCP was $568,967 per QALY compared with BCP and $516,114 per QALY compared with CP. The subgroup analysis demonstrated that PD-L1 expression of ≥50% on tumor cells (TC3) or ≥10% on immune cells (IC3) decreased the incremental cost-effectiveness ratio to $464,703 per QALY. CONCLUSIONS: From the perspective of the US payer, ABCP is estimated to not be cost-effective compared with BCP or CP in the first-line setting for patients with metastatic, nonsquamous NSCLC at a willingness-to-pay threshold of $100,000 per QALY. Cancer 2019;125:3526-3534.

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“…A recent study determined that the ICER of cabozantinib compared with everolimus was $152,452 per QALY . Sarfaty et al estimated that the ICER for nivolumab was $146,532 per QALY versus everolimus and $226,788 per QALY versus everolimus and placebo …”

Section: Kidney Cancermentioning

confidence: 99%

Cost considerations for systemic therapy for patients with advanced genitourinary malignancies

Henry

Leung

Filson

2018

Cancer

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The rising cost of health care in the United States has been the focus of intense debate within the medical, legal, and legislative arenas, with the cost of cancer care representing an important component. Cost effectiveness is not always easy to define, and there is no standard metric in assessing this measure related to cancer therapies. Significant controversy surrounds exactly what is the appropriate cost per added year of life. This review examines cost, effectiveness, and comparative cost effectiveness of novel systemic therapies for patients with urologic malignancies. Cancer 2018;124:2897-905. © 2018 American Cancer Society.

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Cost Effectiveness of Nivolumab in Advanced Renal Cell Carcinoma

Cited by 60 publications

References 24 publications

A Cost-Effectiveness Analysis of Nivolumab and Ipilimumab Versus Sunitinib in First-Line Intermediate- to Poor-Risk Advanced Renal Cell Carcinoma

A Cost-Effectiveness Analysis of Nivolumab and Ipilimumab Versus Sunitinib in First-Line Intermediate- to Poor-Risk Advanced Renal Cell Carcinoma

First‐line atezolizumab in addition to bevacizumab plus chemotherapy for metastatic, nonsquamous non–small cell lung cancer: A United States–based cost‐effectiveness analysis

Cost considerations for systemic therapy for patients with advanced genitourinary malignancies

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