Cost-Effectiveness of Nivolumab Plus Ipilimumab for the First-Line Treatment of Intermediate/Poor-Risk Advanced and/or Metastatic Renal Cell Carcinoma in Switzerland

• DOI: 10.1007/s41669-023-00395-1
• Publication Date: 2023-02-10T04:14:48Z
• Authors: Esra Çakar; César Oniangue-Ndza; Ralph P. Schneider; Sven L. Klijn; Ursula M. Vogl; Christian Rotherm...; Jessica R. May
• Keywords: Pazopanib

This study assessed the cost-effectiveness of nivolumab plus ipilimumab versus both sunitinib and pazopanib for treatment first-line unresectable advanced renal cell carcinoma (aRCC) from a healthcare system perspective in Switzerland.A three-state partitioned survival model, consisting progression-free, progressed disease, death, was constructed. Efficacy estimates were based on data CheckMate 214 trial (NCT02231749) with minimum follow-up 42 months. Two Swiss oncologists consulted to determine disease management resource use. Costs derived tariff lists outpatient (TARMED Online Browser 1.09) inpatient (2020 diagnosis-related groups) treatments. Drug acquisition costs (ex-factory prices) obtained March 2020 price list published by Federal Office Public Health. Treatment-specific EQ-5D-3L-based utilities using French value set as proxy Switzerland. The model utilized 1-week cycle length 40-year time horizon, effects discounted 3.0% per annum. One-way sensitivity analyses, probabilistic analysis, scenario analyses robustness results.Nivolumab yielded incremental 1.43 life-years 1.36 lifetime quality-adjusted (QALYs) relative at an additional cost 147,453 Francs (CHF) CHF145,643, respectively. With cost-utility ratio CHF108,326 QALY gained sunitinib, CHF106,996 pazopanib, combination can be considered cost-effective option patients aRCC Switzerland, willingness-to-pay threshold CHF200,000. Sensitivity confirmed deterministic results.This showed that ipilimumab, which represents one standard-of-care treatments intermediate- or poor-risk patients, is life-extending