A Cost-Effectiveness Analysis of Nivolumab plus Ipilimumab Versus Pembrolizumab plus Axitinib and Versus Avelumab plus Axitinib in First-Line Treatment of Advanced Renal Cell Carcinoma

Abstract Background There now exist several viable first-line treatment options for metastatic renal cell carcinoma, making the choice of initial therapy difficult. Metrics other than patient factors may be necessary in selecting the most appropriate therapy. We aimed to assess the cost-effectiveness of the three combination therapies currently approved in treatment-naive advanced or metastatic renal cell carcinoma: nivolumab plus ipilimumab (NI), pembrolizumab plus axitinib (PA), and avelumab plus axitinib (AA) from US payer perspective. Patients and Methods Our analysis was performed based on previously obtained data derived from progression free survival and overall survival curves from CheckMate 214, KEYNOTE 426, and JAVELIN Renal 101. Results The total cost of each treatment was found to be $437,556.12 for NI, $450,597.15 for PA, and $542,882.34 for AA, with QALY of 4.04, 3.77, and 2.95 for each combination, respectively. ICER of NI versus PA was ($47,504.73/QALY); of NI versus AA was ($96,533.11/QALY); of PA versus AA was ($113,015.87/QALY). Net health benefit scaled against a WTP threshold of $150,000 per QALY was positive for NI versus PA at 0.36 and versus AA at 1.79, and this index was also positive for PA versus AA at 1.43, indicating that the additional value of these therapies versus their alternatives is more than the extra cost. Conclusion NI was found to be the most cost-effective treatment option over the other considered therapies. PA was found to be cost-effective compared to AA. When patient factors such as social issues and pre-existing conditions do not dictate their first-line therapy, clinicians may use this additional data to make financially conscious choices. Microabstract : There exist several viable first-line treatment options for metastatic renal cell carcinoma, making choice of initial therapy difficult. Metrics other than patient factors, such as cost, may assist in selecting the most appropriate therapy. Using data from CheckMate 214, KEYNOTE 426, and JAVELIN Renal 101, and including costs of medication administration, monitoring, and adverse events, a cost-effectiveness analysis revealed that nivolumab plus ipilimumab is more cost-effective than both pembrolizumab plus axitinib and avelumab plus axitinib.