Jun Chen1, Gaoyun Hu1, Zhuo Chen1, Xiaomin Wan2,3, Chongqing Tan2,3, Xiaohui Zeng4, Zeneng Cheng5. 1. Xiangya School of Pharmacy, Central South University, Changsha, 410013, Hunan, China. 2. Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China. 3. Institute of Clinical Pharmacy, Central South University, Changsha, 410011, Hunan, China. 4. PET-CT Center, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China. 5. Xiangya School of Pharmacy, Central South University, Changsha, 410013, Hunan, China. chengzeneng2019@163.com.
Abstract
BACKGROUND AND OBJECTIVES: In first-line treatment of advanced renal cell carcinoma (aRCC), the KEYNOTE-426 study demonstrated a significant progression-free survival and overall survival for pembrolizumab plus axitinib in comparison with sunitinib. The objective of the current study was to evaluate the cost effectiveness of pembrolizumab plus axitinib versus sunitinib for previously untreated patients with aRCC in China. METHODS: A Markov model was used to estimate the costs and health outcomes of treatment of aRCC with sunitinib or pembrolizumab plus axitinib. Univariable and probabilistic sensitivity analyses were performed to determine the robustness of the model outcomes. Additional subgroup analyses were also performed. The primary outputs of the model included the total cost, life-years (LYs), quality-adjusted LYs (QALYs), and incremental cost-effectiveness ratio (ICER). RESULTS: Pembrolizumab plus axitinib provided an additional 2.461 LYs (1.650 QALYs). The total cost per patient was US$178,725 for pembrolizumab plus axitinib and US$87,693 for sunitinib. The ICER for pembrolizumab plus axitinib was US$55,185/QALY versus sunitinib. Sensitivity analyses found the results to be most sensitive to pembrolizumab cost and overall hazard ratio. The results of subgroup analyses showed that the ICER remained greater than US$32,000/QALY across the all patient subgroups. CONCLUSIONS: Pembrolizumab plus axitinib is not likely to be cost effective versus sunitinib for patients with previously untreated aRCC at a threshold value of US$29,306/QALY.
BACKGROUND AND OBJECTIVES: In first-line treatment of advanced renal cell carcinoma (aRCC), the KEYNOTE-426 study demonstrated a significant progression-free survival and overall survival for pembrolizumab plus axitinib in comparison with sunitinib. The objective of the current study was to evaluate the cost effectiveness of pembrolizumab plus axitinib versus sunitinib for previously untreated patients with aRCC in China. METHODS: A Markov model was used to estimate the costs and health outcomes of treatment of aRCC with sunitinib or pembrolizumab plus axitinib. Univariable and probabilistic sensitivity analyses were performed to determine the robustness of the model outcomes. Additional subgroup analyses were also performed. The primary outputs of the model included the total cost, life-years (LYs), quality-adjusted LYs (QALYs), and incremental cost-effectiveness ratio (ICER). RESULTS:Pembrolizumab plus axitinib provided an additional 2.461 LYs (1.650 QALYs). The total cost per patient was US$178,725 for pembrolizumab plus axitinib and US$87,693 for sunitinib. The ICER for pembrolizumab plus axitinib was US$55,185/QALY versus sunitinib. Sensitivity analyses found the results to be most sensitive to pembrolizumab cost and overall hazard ratio. The results of subgroup analyses showed that the ICER remained greater than US$32,000/QALY across the all patient subgroups. CONCLUSIONS:Pembrolizumab plus axitinib is not likely to be cost effective versus sunitinib for patients with previously untreated aRCC at a threshold value of US$29,306/QALY.
Authors: Brian I Rini; Elizabeth R Plimack; Viktor Stus; Rustem Gafanov; Robert Hawkins; Dmitry Nosov; Frédéric Pouliot; Boris Alekseev; Denis Soulières; Bohuslav Melichar; Ihor Vynnychenko; Anna Kryzhanivska; Igor Bondarenko; Sergio J Azevedo; Delphine Borchiellini; Cezary Szczylik; Maurice Markus; Raymond S McDermott; Jens Bedke; Sophie Tartas; Yen-Hwa Chang; Satoshi Tamada; Qiong Shou; Rodolfo F Perini; Mei Chen; Michael B Atkins; Thomas Powles Journal: N Engl J Med Date: 2019-02-16 Impact factor: 91.245
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Authors: S Bracarda; R Iacovelli; L Boni; M Rizzo; L Derosa; M Rossi; L Galli; G Procopio; M Sisani; F Longo; M Santoni; F Morelli; G Di Lorenzo; A Altavilla; C Porta; A Camerini; B Escudier Journal: Ann Oncol Date: 2015-07-27 Impact factor: 32.976
Authors: Otto Hemminki; Nathan Perlis; Johan Bjorklund; Antonio Finelli; Alexandre R Zlotta; Akseli Hemminki Journal: Eur Urol Open Sci Date: 2020-11-28