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