A cost-effectiveness study found that pembrolizumab plus axitinib was the most effective first-line strategy for patients with advanced renal cell carcinoma (RCC). These findings were published in Frontiers in Pharmacology.

Recent clinical trials have indicated that immune checkpoint inhibitors improved clinical outcomes for patients with advanced RCC, however, whether these therapies are cost-effective or not remains unclear. Researchers from Central South University in China performed a cost analysis of 6 treatment strategies for treatment-naïve patients with advanced RCC. Data were sourced from clinical trials and survival modeling studies.

The treatment strategies in cost order were sunitinib ($239,257.68), pembrolizumab plus axitinib ($270,957.76), nivolumab plus ipilimumab ($306,201.03), avelumab plus axitinib ($432,403.81), nivolumab plus cabozantinib ($484,051.49), and lenvatinib plus pembrolizumab ($562,080.09). These costs are associated with life-years gained of 2.99, 3.31, 3.21, 3.07, 3.91, and 3.44 years, respectively.


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These values indicate that sunitinib and pembrolizumab plus axitinib minimize cost, whereas lenvatinib plus pembrolizumab and nivolumab plus cabozantinib maximized health.

For additional quality-adjusted life years (QALY), the ranking of most QALY gained were nivolumab plus cabozantinib (2.99 years), lenvatinib plus pembrolizumab (2.61 years), pembrolizumab plus axitinib (2.52 years), nivolumab plus ipilimumab (2.42 years), avelumab plus axitinib (2.32 years), and sunitinib (2.13 years).

Taken together, the incremental cost-effectiveness ratio (ICER) was maximized for the pembrolizumab plus axitinib strategy ($81,282 per QALY).

The second-best option was nivolumab plus cabozantinib coming at a cost of $453,391 per QALY.

The other 4 treatment options (lenvatinib plus pembrolizumab, nivolumab plus ipilimumab, avelumab plus axitinib, and sunitinib) were determined not to be economically feasible.

This study may have been limited by a lack of head-to-head data, instead information was sourced from stand-alone trials.

The researchers concluded that pembrolizumab plus axitinib was the most effective front-line therapy for patients with treatment-naïve advanced RCC at a willingness-to-pay threshold of $100,000 per QALY.

Reference

Li S, Li J, Peng L, Li Y, Wan X. Cost-effectiveness of frontline treatment for advanced renal cell carcinoma in the era of immunotherapies. Front Pharmacol. 2021;12:718014. doi:10.3389/fphar.2021.718014