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

Abstract

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.

Cost-Effectiveness of Frontline Treatment for Advanced Renal Cell Carcinoma in the Era of Immunotherapies

“…The administration fee was based on the 2021 CMS Physician Fee Schedule, with the duration of drug infusion based on RCTs and United States Food and Drug Administration package inserts ( Centers for Medicare & Medicaid Services, 2021 ). The overall costs associated with the management of grade 3 or 4 AEs and BSC were obtained from previous literature ( Perrin et al, 2015 ; Swallow et al, 2018 ; Wan et al, 2019 ; Bensimon et al, 2020 ; Lu et al, 2020 ; Watson et al, 2020 ; Agency for Healthcare Research and Quality, US Dept of Health and Human Services (2021) ).…”

Pembrolizumab plus axitinib and nivolumab plus ipilimumab as first-line treatments of advanced intermediate- or poor-risk renal-cell carcinoma: a number needed to treat analysis from the Brazilian private perspective

“…Previous analysis have assessed the relationship between clinical and economic benefits of pembrolizumab, axitinib, nivolumab and ipilimumab, isolated or in combination for mRCC management, using traditional strategies such as costeffectiveness and cost-utility analyses 15,16,39,40 . In Brazil, the National Sanitary Agency (Agência Nacional de Vigilância Sanit aria -ANVISA) is responsible for registering new drugs, an exclusive task of the State that intervenes in the production-consumption relationship by establishing legal rules for granting this registration.…”

“…These studies were conducted before the advent of immunotherapy; thus, the current disease burden may be even higher. Previous studies have evaluated the cost-effectiveness of the new first-line treatment option for mRCC 15,16 , but these analyzes did not involve a cost perspective similar to that of Brazil.…”

The nivolumab/cabozantinib combination and the future of doublets in advanced renal cell cancer treatment

“…Moreover, the cost needed to increase life expectancy by 0.39 years using the pembrolizumab/axitinib combination was approximately $8,61,000 per QALY gained when compared to Nivolumab plus Ipilimumab. 4,5 Also, as highlighted by Przybylski et al in your journal, 6 adding more drugs implies adding up adverse events. Higher incidences of grade 3 side effects were reported with the pembrolizumab/axitinib combination than with sunitinib alone (67% versus 62%).…”