Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel.
Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
Oncologist. 2019 Mar;24(3):366-371. doi: 10.1634/theoncologist.2018-0656. Epub 2019 Feb 1.
The treatment paradigm of advanced renal cell carcinoma (RCC) has changed rapidly in recent years. In first-line treatment of intermediate- to poor-risk patients, the CheckMate 214 study demonstrated a significant survival advantage for nivolumab and ipilimumab versus sunitinib. The high cost of combined immune-modulating agents warrants an understanding of the combination's value by considering both efficacy and cost. The objective of this study was to estimate the cost-effectiveness of nivolumab and ipilimumab compared with sunitinib for first-line treatment of intermediate- to poor-risk advanced RCC from the U.S. payer perspective.
A Markov model was developed to compare the costs and effectiveness of nivolumab and ipilimumab with those of sunitinib in the first-line treatment of intermediate- to poor-risk advanced RCC. Health outcomes were measured in life-years and quality-adjusted life-years (QALYs). Drug costs were based on Medicare reimbursement rates in 2017. We extrapolated survival beyond the trial closure using Weibull distribution. Model robustness was addressed in univariable and probabilistic sensitivity analyses.
The total mean cost per-patient of nivolumab and ipilimumab versus sunitinib was $292,308 and $169,287, respectfully. Nivolumab and ipilimumab generated a gain of 0.978 QALYs over sunitinib. The incremental cost-effectiveness ratio (ICER) for nivolumab and ipilimumab was $125,739/QALY versus sunitinib.
Our analysis established that the base case ICER in the model for nivolumab and ipilimumab versus sunitinib is below what some would consider the upper limit of the theoretical willingness-to-pay threshold in the U.S. ($150,000/QALY) and is thus estimated to be cost-effective.
This article assessed the cost-effectiveness of nivolumab and ipilimumab versus sunitinib for treatment of patients with intermediate- to poor-risk metastatic kidney cancer, from the U.S. payer perspective. It would cost $125,739 to gain 1 quality-adjusted life-year with nivolumab and ipilimumab versus sunitinib in these patients.
近年来，晚期肾细胞癌（RCC）的治疗模式发生了快速变化。在中高危患者的一线治疗中，CheckMate 214 研究表明纳武单抗联合伊匹单抗对比舒尼替尼可显著改善患者的生存获益。联合免疫调节药物的高成本要求我们在考虑疗效和成本的基础上，了解联合治疗的价值。本研究旨在从美国支付者的角度评估纳武单抗联合伊匹单抗对比舒尼替尼一线治疗中高危晚期 RCC 的成本效果。
我们开发了一个 Markov 模型，用于比较纳武单抗联合伊匹单抗与舒尼替尼在中高危晚期 RCC 一线治疗中的成本和效果。健康结果以生命年和质量调整生命年（QALY）来衡量。药物成本基于 2017 年医疗保险报销率。我们使用 Weibull 分布对试验关闭后进行生存外推。通过单变量和概率敏感性分析解决模型稳健性问题。
纳武单抗联合伊匹单抗与舒尼替尼相比，每位患者的总平均治疗成本分别为 292308 美元和 169287 美元。纳武单抗联合伊匹单抗比舒尼替尼多获得 0.978 个 QALY。纳武单抗联合伊匹单抗对比舒尼替尼的增量成本效果比（ICER）为 125739 美元/QALY。
我们的分析结果表明，该模型中纳武单抗联合伊匹单抗对比舒尼替尼的基础病例 ICER 低于一些人认为的美国理论支付意愿阈值上限（15 万美元/QALY），因此估计具有成本效果。
本文从美国支付者的角度评估了纳武单抗联合伊匹单抗对比舒尼替尼治疗中高危转移性肾细胞癌患者的成本效果。对于这些患者，纳武单抗联合伊匹单抗对比舒尼替尼可增加 1 个 QALY 的成本为 125739 美元。
