A Cost-Effectiveness Analysis: First-Line Avelumab Plus Axitinib Versus Sunitinib for Advanced Renal-Cell Carcinoma

Peiyao Lu,Pei Dong,Jiahao Li,Weiting Liang,Jie Jiang,Tao Liu,Hongbing Huang,Zhuojia Chen,Yanming Hong,Tiantian Zhang

doi:10.3389/fphar.2020.00619

Abstract

BackgroundCompared with the standard of care with sunitinib, avelumab plus axitinib can increase progression-free survival in the first-line of advanced renal cell carcinoma (RCC), but the economic effect of the treatment is unknown. The purpose of the research was to evaluate the cost-effectiveness of the avelumab plus axitinib versus sunitinib in first-line treatment for advanced RCC from the US payer perspective.MethodsA Markov model was developed to evaluate the economic and health outcomes of avelumab plus axitinib vs sunitinib in the first-line setting for advanced RCC. The clinical data were obtained from the JAVELIN Renal 101 Clinical Trials. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainty in the model. Health outcomes were measured in quality-adjusted life-years (QALYs).ResultsThe incremental cost-effectiveness ratio (ICER) of avelumab plus axitinib compared with sunitinib was $565,232 per QALY, the costs were $884,626 and $669,838, QALYs were 3.67 and 3.29, respectively. Sensitivity analysis demonstrated that differences in utilities in PFS and after progression were the most influential factors within the model. When avelumab was at 30% of the full price or axitinib was at 40% of the full price, avelumab and axitinib were approved to be cost-effective if the WTP threshold was $150,000 per QALY. The subgroup analysis showed the ICER of avelumab plus axitinib compared with sunitinib for the patients with PD-L1–positive tumors was $588,105.ConclusionAvelumab plus axitinib in the first-line treatment was not cost-effective in comparison with sunitinib when the threshold of willingness to pay (WTP) was $150,000 per QALY.

Highlights

The United States has the highest incidence of kidney cancer in the world, with a cumulative risk of 1.8 percent for men and 0.9 percent for women (Capitanio et al, 2019)
The incremental cost-effectiveness ratio (ICER) of avelumab plus axitinib compared with sunitinib was $565,232 per quality-adjusted life-years (QALYs), the costs were $884,626 and $669,838, QALYs were 3.67 and 3.29, respectively
When avelumab was at 30% of the full price or axitinib was at 40% of the full price, avelumab and axitinib were approved to be cost-effective if the willingness to pay (WTP) threshold was $150,000 per QALY

Summary

Introduction

The United States has the highest incidence of kidney cancer in the world (an age-standardized rate of 12 per 100,000), with a cumulative risk of 1.8 percent for men and 0.9 percent for women (Capitanio et al, 2019). There are six antibodies against PD-1 or PD-L1 approved by the United States Food and Drug Administration (FDA): nivolumab, pembrolizumab, atezolizumab, avelumab, durvalumab, and cemiplimab. FDA has approved nivolumab, pembrolizumab, avelumab as the first-line treatment for patients with advanced RCC (FDA, 2019c). Compared with the standard of care with sunitinib, avelumab plus axitinib can increase progression-free survival in the first-line of advanced renal cell carcinoma (RCC), but the economic effect of the treatment is unknown. The purpose of the research was to evaluate the cost-effectiveness of the avelumab plus axitinib versus sunitinib in firstline treatment for advanced RCC from the US payer perspective

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