mRCC: frontline nivolumab+ipilimumab is cost-effective

  • Wan X & al.
  • JAMA Oncol
  • 21 Feb 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • Nivolumab+ipilimumab is estimated to be cost-effective vs sunitinib in intermediate- and poor-risk patients with metastatic renal cell carcinoma (mRCC) and added 0.96 quality-adjusted life year (QALY).

Why this matters

  • Patients with cancer are at risk for financial difficulties, which can lead to delay, abandonment, and discontinuation of treatment.

Study design

  • Cost-efficacy analysis of data from the CheckMate 214 randomized clinical trial.
  • 1096 intermediate-/poor-risk patients with mRCC were randomly assigned to first-line nivolumab+ipilimumab or sunitinib.
  • Funding: National Natural Science Foundation of China; Health and Family Planning Commission of Hunan province.

Key results

  • Nivolumab+ipilimumab showed an additional 0.96 QALY gain and increased treatment cost by $108,363/QALY vs sunitinib.
    • Treatment cost falls within accepted thresholds of $100,000-$150,000 per QALY.
  • Cost-effectiveness probability at willingness-to-pay (WTP) threshold of $150,000 per QALY was higher in:
    • patients with programmed cell death 1 ligand 1 (PD-L1) expression ≥1%: 97%;
    • patients aged
    • female patients: 92%; and
    • patients free of lymph-node metastases, 91%.
  • The incremental cost-effectiveness ratio was higher than a WTP threshold when the OS was increased to the upper limit of the 95% CI (0.89) or the patient’s weight increased to 200 kg.

Limitations

  • Medicare reimbursement data were used to estimate the treatment cost.

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