Medical Decision and Economic Group, Department of Pharmacy, South Campus, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Department of Clinical Oncology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
J Immunother Cancer. 2018 Nov 20;6(1):124. doi: 10.1186/s40425-018-0440-9.
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.
A 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.
Nivolumab 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.
Nivolumab 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.
纳武利尤单抗联合伊匹木单抗在晚期肾细胞癌（RCC）一线治疗中较舒尼替尼改善总生存期且毒性更小。本研究旨在评估纳武利尤单抗联合伊匹木单抗作为晚期 RCC 一线治疗方案从高、中收入国家支付方角度的成本效果。
构建决策分析模型，以评估舒尼替尼和纳武利尤单抗联合伊匹木单抗一线治疗晚期 RCC 的健康和经济结果。临床和效用数据来自已发表的报告。成本数据是从美国（US）、英国（UK）和中国的支付方角度获得的。进行敏感性分析以检验结果的不确定性。使用质量调整生命年（QALY）和增量成本效果比（ICER）。
纳武利尤单抗联合伊匹木单抗比舒尼替尼多获得 0.70-0.76 QALY。我们的分析确定纳武利尤单抗联合伊匹木单抗与舒尼替尼相比，在一线晚期 RCC 治疗中的以下 ICER：美国为 85506 美元/QALY；英国为 126499 美元/QALY；中国为 4682 美元/QALY。敏感性分析发现，体重和纳武利尤单抗、舒尼替尼和伊匹木单抗的价格对模型输出的影响最大。
与标准舒尼替尼相比，纳武利尤单抗联合伊匹木单抗作为一线治疗可使晚期 RCC 获得更多的健康获益，在美国和中国被认为是具有成本效果的，但在英国并非如此。
