Cost–Effectiveness Analysis of Nivolumab Plus Cabozantinib Versus Sunitinib as First-Line Therapy in Advanced Renal Cell Carcinoma

Abstract

Aim: To evaluate the cost–effectiveness of first-line treatment for advanced renal cell carcinoma with nivolumab plus cabozantinib versus sunitinib from a US payer perspective. Methods: Economic outcomes were estimated with Markov and partitioned survival models. Efficacy, safety and other data were taken from the CheckMate 9ER trial. Costs and utilities were gathered from published sources. Sensitivity analyses addressed model uncertainties. Results: The incremental cost–effectiveness ratio of nivolumab plus cabozantinib versus sunitinib was US$555,663 and $531,748 per quality-adjusted life year in the Markov and partitioned survival models, respectively, exceeding the willingness-to-pay threshold (US$150,000 per quality-adjusted life-year). Sensitivity analyses showed robust outcomes. Conclusion: From a US payer perspective, first-line nivolumab plus cabozantinib for advanced renal cell carcinoma is not cost effective.

Plain language summary

Renal cell carcinoma (RCC) is a common cancer in the USA. Up to 30% of patients with RCC are in an advanced stage of disease at diagnosis. RCC is difficult to cure, with an 11% chance of survival after 5 years for patients with advanced RCC. A recent clinical study showed that nivolumab plus cabozantinib (NC) had a greater benefit in patients with advanced RCC than sunitinib. The US FDA approved NC for advanced RCC, but NC is relatively expensive. This study explored the cost–effectiveness of NC for advanced RCC versus sunitinib for a US payer using two cost–effectiveness models developed based on the results of the aforementioned clinical study. The results showed that to gain an additional year in perfect health, NC costs an average of US$555,663 or $531,748 more versus sunitinib, which is more than a US payer is willing to pay for an additional year in perfect health ($150,000). Therefore, NC for advanced RCC is not cost-effective versus sunitinib for a US payer at current prices.

Keywords::

• cabozantinib
• cost–effectiveness
• nivolumab
• renal cell carcinoma
• sunitinib

Supplementary data

To view the supplementary data that accompany this paper please visit the journal website at: www.tandfonline.com/doi/suppl/10.2217/imt-2021-0156

Author contributions

R Liu developed the economic model and performed the analyses. R Liu and K Qiu interpreted the results and wrote the draft of the manuscript. R Liu, K Qiu, J Wu, Y Jiang and P Wu reviewed, analyzed and interpreted the data. J Pang contributed to the design of the primary model and the interpretation of the results. All authors reviewed and approved the final manuscript.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants, or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

This article is based on previously conducted studies and does not contain any studies with human participants or animals performed by any of the authors.