KEY TAKEAWAYS
- The study aimed to assess health and economic outcomes for the treatment of intermediate/poor-risk pts with mRCC.
- The key determinants of the study were OS, PFS, and QALYs.
- The study favors nivo+ ipi + cabo as a first-line for mRCC, potentially saving up to 45%.
Immuno-oncology (IO) and VEGF-targeted tyrosine kinase inhibitor (TKI) combinations have transformed the treatment of patients (pts) with metastatic renal cell carcinoma (mRCC). However, evidence on the most cost-effective sequencing of these systemic therapies is lacking.
Hedyeh Ebrahimi and the team aimed to assess health and economic outcomes for the treatment of pts with RCC sequences in intermediate/poor risk (US payer perspective).
Researchers developed a model using a continuous time microsimulation framework to assess treatment outcomes for newly diagnosed intermediate/poor-risk pts with RCC. The nivolumab (nivo)+ipilimumab (ipi) , nivo+cabo, pembrolizumab (pembro) + lenvatinib, and pembro + axitinib were employed as the first-line options, while cabo and everolimus + lenvatinib were the second-line options.
Overall survival (OS) and progression-free survival (PFS) data were obtained from registrational RCTs for each therapy. The cost covered drug acquisition, administration, monitoring, adverse event management, disease control, and end-of-life care. First-line IO and TKI therapies were limited to a maximum 2-year duration.
Quality-adjusted life-years (QALYs) were calculated by multiplying disease phase durations with utility values derived from CheckMate 214 (NCT02231749) trial data using US tariffs. The analysis ran 1000 simulations for cohorts of 100 pts over a 20-year period. The costs and the health outcomes were discounted at a 3% rate per anum.
Average per-patient QALYs were estimated for each treatment sequence: cabo (3.59) after nivo + ipi , lenvatinib + everolimus (3.26) after nivo + ipi, cabo (3.14) after pembro + axitinib, lenvatinib+everolimus (2.97) after pembro + axitinib, cabo (3.51) after pembro + lenvatinib, and lenvatinib + everolimus (2.99) after nivo + cabo.
Average per-patient costs were estimated for each treatment sequence: nivo + ipi followed by cabo ($468,856), nivo + ipi followed by lenvatinib + everolimus ($491,259), pembro + axitinib followed by cabo ($675,714), pembro+axitinib followed by lenvatinib + everolimus ($700,411), pembro + lenvatinib followed by cabo ($837,888), nivo+cabo followed by lenvatinib+everolimus ($873,377). First-line drug acquisition costs represented the predominant cost component across all treatment sequences.
The study concluded that on the basis of the developed model, first-line nivo+ipi followed by cabo emerged as the dominant treatment strategy for intermediate/ poor-risk pts with mRCC in the US, which offered an estimation of saving the cost of up to 45% vs. IO+TKI options. Further research is warranted to elucidate whether these cost savings translate to the real-world setting.
The funding information was not provided for this study.
Source: https://kcrs.kidneycan.org/wp-content/uploads/2024/06/KCRS24-Abstract-Book-6.27.24.pdf
Clinical trial identifier is not applicable for this study.
Ebrahimi H, Berardi A, Smare C, et al. (2024). “Cost-effectiveness of treatment sequences with front-line nivolumab+ipilimumab therapy vs immuno-oncology+tyrosine kinase inhibitor therapies in intermediate/ poor-risk metastatic renal cell carcinoma.” Presented at KCRS 2024 (Abstract 37).
