PD59-05 COST EFFECTIVENESS OF ADJUVANT PEMBROLIZUMAB AFTER NEPHRECTOMY FOR RCC: INSIGHTS FOR PATIENT SELECTION FROM A MARKOV MODEL

Abstract

You have accessJournal of UrologyCME1 May 2022PD59-05 COST EFFECTIVENESS OF ADJUVANT PEMBROLIZUMAB AFTER NEPHRECTOMY FOR RCC: INSIGHTS FOR PATIENT SELECTION FROM A MARKOV MODEL Vidit Sharma, Kevin M. Wymer, Daniel D. Joyce, James Moriarty, Bijan J. Borah, R. Houston Thompson, Brian A. Costello, Bradley C. Leibovich, and Stephen A. Boorjian Vidit SharmaVidit Sharma More articles by this author , Kevin M. WymerKevin M. Wymer More articles by this author , Daniel D. JoyceDaniel D. Joyce More articles by this author , James MoriartyJames Moriarty More articles by this author , Bijan J. BorahBijan J. Borah More articles by this author , R. Houston ThompsonR. Houston Thompson More articles by this author , Brian A. CostelloBrian A. Costello More articles by this author , Bradley C. LeibovichBradley C. Leibovich More articles by this author , and Stephen A. BoorjianStephen A. Boorjian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002644.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: KEYNOTE-564 found that adjuvant pembrolizumab after nephrectomy for high-risk clear cell renal cell carcinoma (RCC) decreased the risk of disease progression and overall mortality–albeit with immature follow-up (2 years). Herein, we used a Markov-model to consider the costs, toxicities, and efficacy of pembrolizumab and investigate its utility at a population level. METHODS: A decision-analytic Markov Model was used to conduct a cost-utility analysis of adjuvant pembrolizumab versus placebo after nephrectomy for high-risk clear cell RCC, using data from KEYNOTE-564 to inform model probabilities. Utility values were extracted from the literature. Base-case analyses were conducted with 5-year and 15-year time horizons (using extrapolations from 2-year outcomes). Primary outcomes were Quality-adjusted life years (QALYs), 2021 US Medicare costs, and Incremental cost-effectiveness ratios (ICERs) evaluated with a willingness-to-pay threshold of $100,000/QALY. One-way sensitivity analyses and probabilistic sensitivity analyses with 100,000 Monte-Carlo simulations were performed on model conclusions. RESULTS: Pembrolizumab had higher QALYs and costs relative to placebo (Table). Pembrolizumab was not cost-effective at a 5-year time horizon but did become cost-effective at 15 years. On one-way sensitivity analysis, pembrolizumab became cost-effective at 5-years if: 1) its cost was less than $5,064 (base = $10,278) or 2) if the 5-year risk of progression was 18.8% higher in placebo vs pembrolizumab (base = 9%). Using pembrolizumab’s reported hazard ratio of 0.68 for progression from KEYNOTE-564, we estimated that pembrolizumab would be cost-effective at 5-years for all patients with a Mayo Progression Free Survival Score of 10 or higher. Probabilistic sensitivity analysis found that pembrolizumab was cost-effective for 29% and 58% of microsimulations at 5 and 15 years, respectively. CONCLUSIONS: At current prices, adjuvant pembrolizumab was not cost-effective for all trial patients at a population level at 5-years after treatment, though it did emerge to be cost-effective at 15 years. At 5-years, adjuvant pembrolizumab was found to be cost-effective only for the highest risk subsets of RCC. Longer term trial data of progression-free survival and overall survival are necessary to confirm these extrapolations. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e1020 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vidit Sharma More articles by this author Kevin M. Wymer More articles by this author Daniel D. Joyce More articles by this author James Moriarty More articles by this author Bijan J. Borah More articles by this author R. Houston Thompson More articles by this author Brian A. Costello More articles by this author Bradley C. Leibovich More articles by this author Stephen A. Boorjian More articles by this author Expand All Advertisement PDF DownloadLoading ...