TY - JOUR
T1 - Cost-effectiveness of pembrolizumab with axitinib as first-line treatment for advanced renal cell carcinoma
AU - Bensimon, Arielle G.
AU - Zhong, Yichen
AU - Swami, Umang
AU - Briggs, Allison
AU - Young, Joshua
AU - Feng, Yuan
AU - Song, Yan
AU - Signorovitch, James
AU - Adejoro, Oluwakayode
AU - Chakravarty, Abhiroop
AU - Chen, Mei
AU - Perini, Rodolfo F.
AU - Geynisman, Daniel M.
N1 - Publisher Copyright:
© 2020 Merck Sharp & Dohme Corp. Published by Informa UK Limited, trading as Taylor & Francis Group.
PY - 2020/9/1
Y1 - 2020/9/1
N2 - Objective: Pembrolizumab/axitinib significantly prolonged overall survival (OS) and progression-free survival (PFS), and increased objective response rate versus sunitinib in the phase III trial KEYNOTE-426 among previously untreated patients with advanced renal cell carcinoma (RCC). This study assessed the cost-effectiveness of pembrolizumab/axitinib versus other first-line treatments of advanced RCC from a US public healthcare payer perspective. Methods: A partitioned survival model with three states (progression-free, progressed, death) evaluated lifetime costs and quality-adjusted life-years (QALYs) for pembrolizumab/axitinib and other first-line regimens: sunitinib, pazopanib and avelumab/axitinib in the overall population; and sunitinib, cabozantinib and nivolumab/ipilimumab in the subgroup with intermediate/poor prognostic risk. Costs of treatments, adverse events and medical resources were estimated. OS, PFS and treatment duration were extrapolated using parametric models fitted to KEYNOTE-426 data and hazard ratios from network meta-analyses. Utilities were derived through mixed-effects regressions of KEYNOTE-426 EuroQol-5 Dimensions-3 Levels data. Results: In the overall population, pembrolizumab/axitinib was associated with incremental cost-effectiveness ratios (ICERs) of $95,725/QALY versus sunitinib and $128,210/QALY versus pazopanib, and was dominant (lower cost, higher effectiveness) versus avelumab/axitinib, with incremental QALY gains of 2.73, 2.40 and 1.80 versus these therapies, respectively. In the intermediate/poor-risk subgroup, base-case ICERs for pembrolizumab/axitinib were $101,030/QALY versus sunitinib, $6989/QALY versus cabozantinib, and $130,934/QALY versus nivolumab/ipilimumab, with incremental QALY gains of 2.62, 1.78 and 1.06 versus these therapies. Conclusions: In this economic evaluation, pembrolizumab/axitinib was associated with higher life expectancy and QALYs and, based on typical willingness-to-pay thresholds of $150,000–$180,000/QALY, was found cost-effective versus other first-line treatments for advanced RCC in the US.
AB - Objective: Pembrolizumab/axitinib significantly prolonged overall survival (OS) and progression-free survival (PFS), and increased objective response rate versus sunitinib in the phase III trial KEYNOTE-426 among previously untreated patients with advanced renal cell carcinoma (RCC). This study assessed the cost-effectiveness of pembrolizumab/axitinib versus other first-line treatments of advanced RCC from a US public healthcare payer perspective. Methods: A partitioned survival model with three states (progression-free, progressed, death) evaluated lifetime costs and quality-adjusted life-years (QALYs) for pembrolizumab/axitinib and other first-line regimens: sunitinib, pazopanib and avelumab/axitinib in the overall population; and sunitinib, cabozantinib and nivolumab/ipilimumab in the subgroup with intermediate/poor prognostic risk. Costs of treatments, adverse events and medical resources were estimated. OS, PFS and treatment duration were extrapolated using parametric models fitted to KEYNOTE-426 data and hazard ratios from network meta-analyses. Utilities were derived through mixed-effects regressions of KEYNOTE-426 EuroQol-5 Dimensions-3 Levels data. Results: In the overall population, pembrolizumab/axitinib was associated with incremental cost-effectiveness ratios (ICERs) of $95,725/QALY versus sunitinib and $128,210/QALY versus pazopanib, and was dominant (lower cost, higher effectiveness) versus avelumab/axitinib, with incremental QALY gains of 2.73, 2.40 and 1.80 versus these therapies, respectively. In the intermediate/poor-risk subgroup, base-case ICERs for pembrolizumab/axitinib were $101,030/QALY versus sunitinib, $6989/QALY versus cabozantinib, and $130,934/QALY versus nivolumab/ipilimumab, with incremental QALY gains of 2.62, 1.78 and 1.06 versus these therapies. Conclusions: In this economic evaluation, pembrolizumab/axitinib was associated with higher life expectancy and QALYs and, based on typical willingness-to-pay thresholds of $150,000–$180,000/QALY, was found cost-effective versus other first-line treatments for advanced RCC in the US.
KW - Antibodies, Monoclonal, Humanized/administration & dosage
KW - Axitinib/administration & dosage
KW - Carcinoma, Renal Cell/drug therapy
KW - Cost-Benefit Analysis
KW - Female
KW - Health Care Costs
KW - Humans
KW - Kidney Neoplasms/drug therapy
KW - Male
KW - Middle Aged
KW - Progression-Free Survival
KW - Quality-Adjusted Life Years
UR - http://www.scopus.com/inward/record.url?scp=85089258953&partnerID=8YFLogxK
U2 - 10.1080/03007995.2020.1799771
DO - 10.1080/03007995.2020.1799771
M3 - Article
C2 - 32697113
AN - SCOPUS:85089258953
SN - 0300-7995
VL - 36
SP - 1507
EP - 1517
JO - Current Medical Research and Opinion
JF - Current Medical Research and Opinion
IS - 9
ER -
