Abstract
BackgroundNivolumab plus ipilimumab improves overall survival and is associated with less toxicity compared with sunitinib in the first-line setting of advanced renal-cell carcinoma (RCC). The current study aimed to assess the cost-effectiveness of nivolumab plus ipilimumab for first-line treatment of advanced RCC from the payer perspectives high- and middle-income regions.MethodsA decision-analytic model was constructed to evaluate the health and economic outcomes of first-line sunitinib and nivolumab plus ipilimumab treatment associated with advanced RCC. The clinical and utility data were obtained from published reports. The cost data were acquired for the payer perspectives of the United States (US), United Kingdom (UK), and China. Sensitivity analyses were performed to test the uncertainties of the results. Quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were used.ResultsNivolumab plus ipilimumab gained 0.70–0.76 QALYs compared with sunitinib. Our analysis determined the following ICERs for nivolumab plus ipilimumab over sunitinib in first-line advanced RCC treatment: US $ 85,506 /QALY; UK $ 126,499/QALY; and China $ 4682/QALY. Sensitivity analyses found the model outputs to be most affected for body weight and for the prices of nivolumab, sunitinib and ipilimumab.ConclusionsNivolumab plus ipilimumab as first-line treatment could gain more health benefits for advanced RCC in comparison with standard sunitinib, which is considered to be cost-effective in the US and China but not in the UK.
Highlights
The Global Burden of Disease 2015 Study presented that kidney cancer accounted for 1.60% of disease burden associated with neoplasms and ranked 14th in deaths [1, 2]
The current study investigated the economic outcomes of introducing nivolumab plus ipilimumab as first-line therapy to the present standard care of patients with advanced renal-cell carcinoma (RCC) in the United States (US), United Kingdom (UK) and China for the extent of transferability and generalizability, which are the representatives of high- and middle-income regions, respectively
Sensitivity analysis The one-way sensitivity analyses revealed that the results of the model were more sensitive to body weight because this variable had the greatest impact on incremental cost-effectiveness ratios (ICERs), which showed that the nivolumab plus ipilimumab strategy would become more favorable as the body weight decreased (Fig. 2)
Summary
The Global Burden of Disease 2015 Study presented that kidney cancer accounted for 1.60% of disease burden associated with neoplasms and ranked 14th in deaths [1, 2]. As the most lethal of the prevalent types of kidney cancer, nearly 30% of patients with renal cell carcinoma (RCC) have locally advanced or metastatic disease at diagnosis because they are generally asymptomatic at disease onset [3, 4]. Nivolumab, a PD-1 inhibitor, has shown survival superiority over everolimus in second-line treatment of metastatic RCC and has been recommended by the clinical guideline [11]. The nivolumab plus ipilimumab (CTLA-4 inhibitor) strategy was granted U.S Food and Drug Administration (FDA) approval as a first-line treatment for adults with advanced RCC. Nivolumab plus ipilimumab improves overall survival and is associated with less toxicity compared with sunitinib in the first-line setting of advanced renal-cell carcinoma (RCC). The current study aimed to assess the cost-effectiveness of nivolumab plus ipilimumab for first-line treatment of advanced RCC from the payer perspectives high- and middle-income regions
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