Cost-Effectiveness of Nivolumab Plus Cabozantinib Versus Sunitinib as a First-Line Treatment for Advanced Renal Cell Carcinoma in the United States
Background: In a recent randomized, phase 3 trial (CheckMate 9ER), nivolumab combined with cabozantinib significantly improved patient outcomes compared with sunitinib. However, the cost-effectiveness of these novel agents for untreated advanced renal cell carcinoma (aRCC) remains unknown.Materials...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-12-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2021.736860/full |
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| author | SiNi Li SiNi Li SiNi Li JianHe Li LiuBao Peng YaMin Li YaMin Li XiaoMin Wan |
| author_facet | SiNi Li SiNi Li SiNi Li JianHe Li LiuBao Peng YaMin Li YaMin Li XiaoMin Wan |
| author_sort | SiNi Li |
| collection | DOAJ |
| description | Background: In a recent randomized, phase 3 trial (CheckMate 9ER), nivolumab combined with cabozantinib significantly improved patient outcomes compared with sunitinib. However, the cost-effectiveness of these novel agents for untreated advanced renal cell carcinoma (aRCC) remains unknown.Materials and Methods: We constructed a microsimulation decision-analytic model to measure the healthcare costs and outcomes of nivolumab plus cabozantinib compared with those of sunitinib for patients with aRCC. The transition probability of patients was calculated from CheckMate 9ER using parametric survival modeling. Lifetime direct medical costs, life years (LYs), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were estimated for nivolumab-plus-cabozantinib treatment compared with sunitinib from a US payer perspective. We conducted one-way and probabilistic sensitivity analyses and a series of scenario analyses to evaluate model uncertainty.Results: Nivolumab plus cabozantinib was associated with an improvement of 0.59 LYs and 0.56 QALYs compared with sunitinib. However, incorporating nivolumab plus cabozantinib into first-line treatment was associated with significantly higher lifetime costs ($483,352.70 vs. $198,320.10), causing the incremental cost-effectiveness ratio for nivolumab plus cabozantinib to be $508,987/QALY. The patients’ age of treatment, first-line utility, and cost of nivolumab had the greatest influence on the model. The outcomes were robust when tested in sensitivity and scenario analyses.Conclusion: For aRCC, substituting nivolumab plus cabozantinib in the first-line setting is unlikely to be cost-effective under the current willingness-to-pay threshold ($150,000/QALY). Significant price decreases for nivolumab used in first-line therapy would be needed to drop ICERs to a more diffusely acceptable value. |
| first_indexed | 2024-12-24T03:07:55Z |
| format | Article |
| id | doaj.art-bb3990ff098d496c8cae1f5c03588678 |
| institution | Directory Open Access Journal |
| issn | 1663-9812 |
| language | English |
| last_indexed | 2024-12-24T03:07:55Z |
| publishDate | 2021-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pharmacology |
| spelling | doaj.art-bb3990ff098d496c8cae1f5c035886782022-12-21T17:17:57ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122021-12-011210.3389/fphar.2021.736860736860Cost-Effectiveness of Nivolumab Plus Cabozantinib Versus Sunitinib as a First-Line Treatment for Advanced Renal Cell Carcinoma in the United StatesSiNi Li0SiNi Li1SiNi Li2JianHe Li3LiuBao Peng4YaMin Li5YaMin Li6XiaoMin Wan7Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, ChinaThe Xiangya Nursing School, Central South University, Changsha, ChinaSchool of Health and Related Research, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, United KingdomDepartment 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: In a recent randomized, phase 3 trial (CheckMate 9ER), nivolumab combined with cabozantinib significantly improved patient outcomes compared with sunitinib. However, the cost-effectiveness of these novel agents for untreated advanced renal cell carcinoma (aRCC) remains unknown.Materials and Methods: We constructed a microsimulation decision-analytic model to measure the healthcare costs and outcomes of nivolumab plus cabozantinib compared with those of sunitinib for patients with aRCC. The transition probability of patients was calculated from CheckMate 9ER using parametric survival modeling. Lifetime direct medical costs, life years (LYs), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were estimated for nivolumab-plus-cabozantinib treatment compared with sunitinib from a US payer perspective. We conducted one-way and probabilistic sensitivity analyses and a series of scenario analyses to evaluate model uncertainty.Results: Nivolumab plus cabozantinib was associated with an improvement of 0.59 LYs and 0.56 QALYs compared with sunitinib. However, incorporating nivolumab plus cabozantinib into first-line treatment was associated with significantly higher lifetime costs ($483,352.70 vs. $198,320.10), causing the incremental cost-effectiveness ratio for nivolumab plus cabozantinib to be $508,987/QALY. The patients’ age of treatment, first-line utility, and cost of nivolumab had the greatest influence on the model. The outcomes were robust when tested in sensitivity and scenario analyses.Conclusion: For aRCC, substituting nivolumab plus cabozantinib in the first-line setting is unlikely to be cost-effective under the current willingness-to-pay threshold ($150,000/QALY). Significant price decreases for nivolumab used in first-line therapy would be needed to drop ICERs to a more diffusely acceptable value.https://www.frontiersin.org/articles/10.3389/fphar.2021.736860/fullcost-effectiveness analysesrenal cell carcinomamicrosimulationnivolumabcabozantinib |
| spellingShingle | SiNi Li SiNi Li SiNi Li JianHe Li LiuBao Peng YaMin Li YaMin Li XiaoMin Wan Cost-Effectiveness of Nivolumab Plus Cabozantinib Versus Sunitinib as a First-Line Treatment for Advanced Renal Cell Carcinoma in the United States Frontiers in Pharmacology cost-effectiveness analyses renal cell carcinoma microsimulation nivolumab cabozantinib |
| title | Cost-Effectiveness of Nivolumab Plus Cabozantinib Versus Sunitinib as a First-Line Treatment for Advanced Renal Cell Carcinoma in the United States |
| title_full | Cost-Effectiveness of Nivolumab Plus Cabozantinib Versus Sunitinib as a First-Line Treatment for Advanced Renal Cell Carcinoma in the United States |
| title_fullStr | Cost-Effectiveness of Nivolumab Plus Cabozantinib Versus Sunitinib as a First-Line Treatment for Advanced Renal Cell Carcinoma in the United States |
| title_full_unstemmed | Cost-Effectiveness of Nivolumab Plus Cabozantinib Versus Sunitinib as a First-Line Treatment for Advanced Renal Cell Carcinoma in the United States |
| title_short | Cost-Effectiveness of Nivolumab Plus Cabozantinib Versus Sunitinib as a First-Line Treatment for Advanced Renal Cell Carcinoma in the United States |
| title_sort | cost effectiveness of nivolumab plus cabozantinib versus sunitinib as a first line treatment for advanced renal cell carcinoma in the united states |
| topic | cost-effectiveness analyses renal cell carcinoma microsimulation nivolumab cabozantinib |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2021.736860/full |
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