Clinical and economic outcomes of treatment sequences for intermediate- to poor-risk advanced renal cell carcinoma
Apoorva Ambavane, Shuo Yang, Michael B Atkins, Sumati Rao, Anshul Shah, Meredith M Regan, David F McDermott, M Dror Michaelson, Apoorva Ambavane, Shuo Yang, Michael B Atkins, Sumati Rao, Anshul Shah, Meredith M Regan, David F McDermott, M Dror Michaelson
Abstract
Aim: To assess the cost-effectiveness of treatment sequences for patients with intermediate- to poor-risk advanced renal cell carcinoma. Patients & methods: A discrete event simulation model was developed to estimate patients' lifetime costs and survival. Efficacy inputs were derived from the CheckMate 214 and CheckMate 025 studies and network meta-analyses. Safety and cost data were obtained from the published literature. Results: The estimated average quality-adjusted life-years (QALYs) gained was the highest on nivolumab + ipilimumab-initiated sequences (3.6-5.3 QALYs) versus tyrosine kinase inhibitor (TKI)-initiated sequences (2.1-3.7 QALYs). Incremental cost per QALY gained for nivolumab + ipilimumab-initiated sequences was below the willingness-to-pay threshold of $150,000 versus other sequences. Conclusion: Immuno-oncology combination therapy followed by TKIs is cost-effective versus TKI sequences followed by immuno-oncology or sequencing TKIs.
Trial registration: ClinicalTrials.gov NCT02231749 NCT01668784.
Keywords: cost–effectiveness; immuno-oncology therapy; renal cell carcinoma; survival; treatment sequences; treatment-free interval.
Source: PubMed