Cost-Effectiveness of Frontline Treatment for Advanced Renal Cell Carcinoma in the Era of Immunotherapies
Background: Recent randomized controlled trials have demonstrated that immune checkpoint inhibitors (ICIs) improve patient outcomes, but whether these novel agents are cost-effective for untreated advanced renal cell carcinoma (aRCC) remains unclear.Materials and Methods: A microsimulation model was...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-09-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2021.718014/full |
| _version_ | 1819115025133993984 |
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| author | SiNi Li SiNi Li JianHe Li LiuBao Peng YaMin Li YaMin Li XiaoMin Wan |
| author_facet | SiNi Li SiNi Li JianHe Li LiuBao Peng YaMin Li YaMin Li XiaoMin Wan |
| author_sort | SiNi Li |
| collection | DOAJ |
| description | Background: Recent randomized controlled trials have demonstrated that immune checkpoint inhibitors (ICIs) improve patient outcomes, but whether these novel agents are cost-effective for untreated advanced renal cell carcinoma (aRCC) remains unclear.Materials and Methods: A microsimulation model was created to project the healthcare costs and outcomes of six strategies (lenvatinib-plus-pembrolizumab, nivolumab-plus-cabozantinib, nivolumab-plus-ipilimumab, pembrolizumab-plus-axitinib, avelumab-plus-axitinib, and sunitinib monotherapy) for patients with aRCC. Transition probability of patients was estimated from CLEAR, CheckMate 9ER, CheckMate 214, KEYNOTE-426, JAVELIN Renal 101, and other data sets by using parametric survival modeling. Lifetime direct medical costs, life years (LYs), quality-adjusted LYs (QALYs), and incremental cost-effectiveness ratios (ICERs) were estimated from a United States payer perspective. One-way and probabilistic sensitivity analyses were performed, along with multiple scenario analyses, to evaluate model uncertainty.Results: Of the six competing strategies, nivolumab-plus-cabozantinib yielded the most significant health outcomes, and the sunitinib strategy was the least expensive option. The cost-effective frontier consisted of the nivolumab-plus-cabozantinib, pembrolizumab-plus-axitinib, and sunitinib strategies, which displayed the ordered ICERs of $81282/QALY for pembrolizumab-plus-axitinib vs sunitinib and $453391/QALY for nivolumab-plus-cabozantinib vs pembrolizumab-plus-axitinib. The rest of the strategies, such as lenvatinib-plus-pembrolizumab, nivolumab-plus-ipilimumab, and avelumab-plus-axitinib, were dominated. The cost of sunitinib drove the model most influentially.Conclusions: For aRCC, the pembrolizumab-plus-axitinib strategy is likely to be the most cost-effective alternative at the willingness-to-pay threshold of $100,000. |
| first_indexed | 2024-12-22T04:54:38Z |
| format | Article |
| id | doaj.art-17b9a9a2519a459dbca57695bef6ef57 |
| institution | Directory Open Access Journal |
| issn | 1663-9812 |
| language | English |
| last_indexed | 2024-12-22T04:54:38Z |
| publishDate | 2021-09-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Pharmacology |
| spelling | doaj.art-17b9a9a2519a459dbca57695bef6ef572022-12-21T18:38:24ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122021-09-011210.3389/fphar.2021.718014718014Cost-Effectiveness of Frontline Treatment for Advanced Renal Cell Carcinoma in the Era of ImmunotherapiesSiNi Li0SiNi Li1JianHe Li2LiuBao Peng3YaMin Li4YaMin Li5XiaoMin Wan6Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, ChinaThe Xiangya Nursing School, Central South University, Changsha, ChinaDepartment of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, ChinaDepartment of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, ChinaClinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, ChinaThe Xiangya Nursing School, Central South University, Changsha, ChinaDepartment of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, ChinaBackground: Recent randomized controlled trials have demonstrated that immune checkpoint inhibitors (ICIs) improve patient outcomes, but whether these novel agents are cost-effective for untreated advanced renal cell carcinoma (aRCC) remains unclear.Materials and Methods: A microsimulation model was created to project the healthcare costs and outcomes of six strategies (lenvatinib-plus-pembrolizumab, nivolumab-plus-cabozantinib, nivolumab-plus-ipilimumab, pembrolizumab-plus-axitinib, avelumab-plus-axitinib, and sunitinib monotherapy) for patients with aRCC. Transition probability of patients was estimated from CLEAR, CheckMate 9ER, CheckMate 214, KEYNOTE-426, JAVELIN Renal 101, and other data sets by using parametric survival modeling. Lifetime direct medical costs, life years (LYs), quality-adjusted LYs (QALYs), and incremental cost-effectiveness ratios (ICERs) were estimated from a United States payer perspective. One-way and probabilistic sensitivity analyses were performed, along with multiple scenario analyses, to evaluate model uncertainty.Results: Of the six competing strategies, nivolumab-plus-cabozantinib yielded the most significant health outcomes, and the sunitinib strategy was the least expensive option. The cost-effective frontier consisted of the nivolumab-plus-cabozantinib, pembrolizumab-plus-axitinib, and sunitinib strategies, which displayed the ordered ICERs of $81282/QALY for pembrolizumab-plus-axitinib vs sunitinib and $453391/QALY for nivolumab-plus-cabozantinib vs pembrolizumab-plus-axitinib. The rest of the strategies, such as lenvatinib-plus-pembrolizumab, nivolumab-plus-ipilimumab, and avelumab-plus-axitinib, were dominated. The cost of sunitinib drove the model most influentially.Conclusions: For aRCC, the pembrolizumab-plus-axitinib strategy is likely to be the most cost-effective alternative at the willingness-to-pay threshold of $100,000.https://www.frontiersin.org/articles/10.3389/fphar.2021.718014/fullcost-effectivenessrenal cell carcinomamicrosimulationimmune checkpoint inhibitorsimmunotherapy |
| spellingShingle | SiNi Li SiNi Li JianHe Li LiuBao Peng YaMin Li YaMin Li XiaoMin Wan Cost-Effectiveness of Frontline Treatment for Advanced Renal Cell Carcinoma in the Era of Immunotherapies Frontiers in Pharmacology cost-effectiveness renal cell carcinoma microsimulation immune checkpoint inhibitors immunotherapy |
| title | Cost-Effectiveness of Frontline Treatment for Advanced Renal Cell Carcinoma in the Era of Immunotherapies |
| title_full | Cost-Effectiveness of Frontline Treatment for Advanced Renal Cell Carcinoma in the Era of Immunotherapies |
| title_fullStr | Cost-Effectiveness of Frontline Treatment for Advanced Renal Cell Carcinoma in the Era of Immunotherapies |
| title_full_unstemmed | Cost-Effectiveness of Frontline Treatment for Advanced Renal Cell Carcinoma in the Era of Immunotherapies |
| title_short | Cost-Effectiveness of Frontline Treatment for Advanced Renal Cell Carcinoma in the Era of Immunotherapies |
| title_sort | cost effectiveness of frontline treatment for advanced renal cell carcinoma in the era of immunotherapies |
| topic | cost-effectiveness renal cell carcinoma microsimulation immune checkpoint inhibitors immunotherapy |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2021.718014/full |
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