A Cost-Effectiveness Analysis of Nivolumab Plus Ipilimumab Versus Pembrolizumab Plus Axitinib and Versus Avelumab Plus Axitinib in First-Line Treatment of Advanced Renal Cell Carcinoma

There exist several viable first-line treatment options for metastatic renal cell carcinoma, making the choice of initial therapy difficult. Metrics other than patient factors, such as cost, may assist in selecting the most appropriate therapy. Using data from CheckMate 214, KEYNOTE 426, and JAVELIN Renal 101 and including costs of medication administration, monitoring, and adverse events, a cost-effectiveness analysis revealed that nivolumab + ipilimumab is more cost-effective than both pembrolizumab + axitinib and avelumab + axitinib. Background: There now exist several viable first-line treatment options for metastatic renal cell carcinoma, making the choice of initial therapy difficult. Considering metrics other than patient factors may be necessary to select the most appropriate therapy. We aimed to assess the cost-effectiveness of the three combination therapies currently approved in treatment-naive advanced or metastatic renal cell carcinoma- nivolumab + ipilimumab (NI), pembrolizumab + axitinib (PA), and avelumab + axitinib (AA)-from a US payer perspective. Patients and Methods: Our analysis was performed based on previously obtained data derived from progression-free survival and overall survival curves from CheckMate 214, KEYNOTE 426, and JAVELIN Renal 101. Results: The total costs of each treatment were found to be $437,556.12 for NI, $450,597.15 for PA, and $542,882.34 for AA, with quality-adjusted life-year (QALY) values of 4.04, 3.77, and 2.95 for each combination, respectively. The incremental cost-effectiveness ratio (ICER) of NI versus PA was ($47,504.73/QALY); for NI versus AA, it was ($96,533.11/QALY); for PA versus AA, it was ($113,015.87/QALY). Net health benefit scaled against a willingness-to-pay threshold of $150,000 per QALY was positive for NI versus PA at 0.36 and versus AA at 1.79, and this index was also positive for PA versus AA at 1.43, indicating that the additional value of these therapies versus their alternatives is greater than the extra cost. Conclusion: NI was found to be the most cost-effective treatment option compared with the other considered therapies. PA was found to be cost effective compared to AA. When patient factors such as social issues and pre-existing conditions do not dictate their first-line therapy, clinicians may use this additional information to make financially conscious choices. (C) 2021 Elsevier Inc. All rights reserved.