Cost Effectiveness of Nivolumab in Advanced Renal Cell Carcinoma

• Published in: European urology Vol. 73; no. 4; pp. 628 - 634
• Main Authors: Sarfaty, Michal, Leshno, Moshe, Gordon, Noa, Moore, Assaf, Neiman, Victoria, Rosenbaum, Eli, Goldstein, Daniel A.
• Format: Journal Article
• Language: English
• Published: Switzerland Elsevier B.V 01.04.2018
• Subjects: Antineoplastic Agents, Immunological - adverse effects; Antineoplastic Agents, Immunological - economics; Antineoplastic Agents, Immunological - therapeutic use; Carcinoma, Renal Cell - drug therapy; Carcinoma, Renal Cell - economics; Carcinoma, Renal Cell - pathology; Cost Effectiveness; Cost-Benefit Analysis; Disease-Free Survival; Drug Costs; Everolimus; Everolimus - adverse effects; Everolimus - economics; Everolimus - therapeutic use; Female; Humans; Immunotherapy; Israel; Kidney Neoplasms - drug therapy; Kidney Neoplasms - economics; Kidney Neoplasms - pathology; Male; Markov Chains; Middle Aged; Models, Economic; Neoplasm Staging; Nivolumab - adverse effects; Nivolumab - economics; Nivolumab - therapeutic use; Programmed death 1 receptor; Quality-Adjusted Life Years; Renal cell carcinoma; Israel; Cost Effectiveness; Programmed death 1 receptor; Renal cell carcinoma; Everolimus; Immunotherapy
• ISSN: 0302-2838; 1873-7560
• DOI: 10.1016/j.eururo.2017.07.041

In recent years, new drugs have been introduced for second-line treatment of advanced renal cell carcinoma (RCC). Nivolumab increases overall survival and is associated with less toxicity compared to everolimus in this setting according to the CheckMate 025 study. However, because of the high cost of nivolumab, there is a need to define its value by considering both efficacy and cost. To estimate the cost effectiveness of nivolumab for second-line treatment of advanced RCC from the US payer perspective. A Markov model was developed to compare the costs and effectiveness of nivolumab with those of everolimus and placebo in second-line treatment of advanced RCC. Health outcomes were measured in life-years (LYs) and quality-adjusted LYs (QALYs). Drug costs were based on 2016 Medicare reimbursement rates. Model robustness was assessed in univariable and probabilistic sensitivity analyses. We addressed the issue of the extensive duration of immunotherapy treatment among long-term survivors, which may or may not be approved by payers. The total mean cost per patient was $101 070 for nivolumab and $50 935 for everolimus. Nivolumab generated a gain of 0.24 LYs (0.34 QALYs) compared to everolimus. The incremental cost-effectiveness ratio (ICER) for nivolumab was $146 532/QALY versus everolimus and $226 197/QALY versus placebo. Limiting the maximal treatment duration of nivolumab to 2 yr reduced the ICER to $121 788/QALY versus everolimus. The analysis is limited by data availability and our assumptions. Our analysis established that with a willingness-to-pay threshold of $100 000 to $150 000 per QALY, nivolumab is estimated to be cost-effective versus everolimus, but not cost-effective versus placebo. We assessed the cost effectiveness of nivolumab in previously treated metastatic kidney cancer. In the USA, it would cost $146 532 to gain one quality-adjusted life-year with nivolumab versus everolimus, or $226 197 versus placebo. Nivolumab is considered cost-effective versus everolimus, but not versus placebo. In previously treated metastatic kidney cancer in the USA, it would cost $146 532 to gain one quality-adjusted life-year with nivolumab versus everolimus, or $226 197 versus placebo. Nivolumab is estimated to be cost effective versus everolimus, but not versus placebo.