Cost-effectiveness of pembrolizumab with axitinib as first-line treatment for advanced renal cell carcinoma. (1st September 2020)

• Record Type: Journal Article
• Authors: Bensimon, Arielle G.; Zhong, Yichen; Swami, Umang; Briggs, Allison; Young, Joshua; Feng, Yuan; Song, Yan; Signorovitch, James; Adejoro, Oluwakayode; Chakravarty, Abhiroop; Chen, Mei; Perini, Rodolfo F.; Geynisman, Daniel M.
• Is Part Of: Current medical research and opinion. Volume 36:Number 9(2020)
• Page Start: 1507
• Page End: 1517
• Publication Date: 2020-09-01
• Subjects: Renal cell carcinoma -- first-line therapy -- pembrolizumab -- axitinib -- cost-effectiveness -- partitioned survival model; Clinical medicine -- Periodicals; Therapeutics -- Periodicals; 615.5
• DOI: 10.1080/03007995.2020.1799771
• Languages: English
• ISSNs: 0300-7995

Abstract

Abstract: 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.