PCN51 A COST-EFFCTIVENESS ANALYSIS OF PEMBROLIZUMAB PLUS AXITINIB VERSUS SUNITINIB FOR FIRST-LINE TREATMENT OF ADVANCED RENAL CELL CARCINOMA

Abstract

To evaluate the cost-effectiveness of pembrolizumab plus axitinib compared with sunitinib for first-line treatment of advanced renal cell carcinoma from a third-party payer perspective in the U.S. A Markov model with a cycle length of 6 weeks was constructed to simulate three health states: progression-free, progressive disease and death. The model was run until 99% patients died. Both health outcomes and costs were discounted at an annual rate of 3%. Clinical parameters were informed by the KEYNOTE-426 trial. Cost data including drug acquisition costs, administration costs and adverse event costs were derived from government reimbursement schedules and published literature and adjusted to 2019 USD. Utility values of different health states and disutility from adverse events were obtained from published literature. Outcomes were measured as incremental cost-effectiveness ratios (ICERs) and net monetary benefits (NMBs). One-way sensitivity analysis was performed to test the robustness of the model. In the base case, pembrolizumab plus axitinib generated a gain of 3.25 life years (5.11 vs. 1.86) and 1.35 quality-adjusted life years (QALYs) (3.03 vs. 1.68) over sunitinib at an additional cost of $343,966 ($619,701 vs. $275,735), yielding an ICER of $254,987/QALY. One-way sensitivity analysis shows that results are most sensitive to median overall survival, median progression-free survival, and drug costs of the pembrolizumab plus axitinib group. Pembrolizumab plus axitinib had a higher NMB than sunitinib only at willingness-to-pay (WTP) thresholds larger than or equal to $270K/QALY. Using a WTP threshold of $150K/QALY, pembrolizumab plus axitinib is not likely to be cost effective for first-line treatment of renal cell carcinoma at current list price compared to sunitinib.