Vascular Endothelial Growth Factor Receptor Inhibitors in Chinese Patients With Advanced Radioactive Iodine-Refractory Differentiated Thyroid Cancer: A Network Meta-Analysis and Cost-Effectiveness Analysis

Youwen Zhu, Kun Liu, Kailing Wang, Libo Peng, Youwen Zhu, Kun Liu, Kailing Wang, Libo Peng

Abstract

Introduction: Two targeted drugs (apatinib and lenvatinib) show clinical efficacy in first-line treatment of Chinese patients with radioactive advanced iodine-refractory differentiated thyroid cancer (RAIR-DTC) and are recommended by the Chinese Society of Clinical Oncology guidelines. Considering the high clinical cost of long-term vascular endothelial growth factor receptor inhibitor administration and to determine which of the two targeted drugs is preferable, we opted to conduct a cost-effectiveness analysis (CEA) and network meta-analysis (NMA).

Material and methods: The results of NMA and CEA included in the two phase III randomized clinical trials REALITY (NCT03048877) and Study-308 (NCT02966093), in which Bayesian NMA and CEA were performed on 243 and 149 Chinese patients, respectively, were retrieved. Overall survival and progression-free survival (PFS) for apatinib versus lenvatinib were determined by NMA. CEA involved the development of a 20-year Markov model to obtain the total cost and quality-adjusted life-years (QALYs), and this was followed by sensitivity and subgroup analyses.

Results: Compared with lenvatinib, apatinib therapy provided a 0.837 improvement in QALY and $6,975 reduction in costs. The hazard ratio of apatinib versus lenvatinib and the cost of the targeted drugs had a significant impact on the model. According to the sensitivity analysis, apatinib was more cost-effective and had no correlation with willingness-to-pay in China. Subgroup analysis showed that apatinib maintained PFS more economically.

Conclusion: NMA and CEA demonstrated that apatinib was more cost-effective compared to lenvatinib in the first-line treatment of Chinese RAIR-DTC patients.

Keywords: advanced radioactive iodine-refractory differentiated thyroid cancer; apatinib; cost-effectiveness analysis; lenvatinib; network meta-analysis.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Zhu, Liu, Wang and Peng.

Figures

Figure 1
Figure 1
The one-way sensitivity analyses of the apatinib vs Lenvatinib. PFS, progression-free survival; PD, disease progression; OS, overall survival; BSC, best supportive care; AEs, adverse events.
Figure 2
Figure 2
The cost-effectiveness acceptability curves for the apatinib vs Lenvatinib. QALY, quality-adjusted life-year.

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