Cost-effectiveness of nivolumab and ipilimumab versus pembrolizumab and axitinib in advanced renal cell carcinoma with intermediate or poor prognostic risk: a Brazilian private healthcare system perspective.

Autor:	Dhanji N; Modeling & Meta-Analysis, OPEN Health, Oxford, UK., Decimoni TC; Health Economics and Outcomes Research, Bristol Myers Squibb, São Paulo, SP, Brazil., Dyer MTD; WW Health Economics and Outcomes Research, Bristol Myers Squibb, Uxbridge, UK., May JR; WW Health Economics and Outcomes Research, Bristol Myers Squibb, Uxbridge, UK., van de Wetering G; Modeling & Meta-Analysis, OPEN Health, Rotterdam, Netherlands., Petersohn S; Modeling & Meta-Analysis, OPEN Health, Rotterdam, Netherlands., Nickel K; Modeling & Meta-Analysis, OPEN Health, Berlin, Germany., Silva A; Commercialization Intercon Medical, Medical and Regulatory Affairs, São Paulo, SP, Brazil., Muniz DQB; Hospital Sírio-Libanês, São Paulo, Brazil., Casagrande D Oliveira AP; Health Economics and Outcomes Research, Bristol Myers Squibb, São Paulo, SP, Brazil.
Jazyk:	angličtina
Zdroj:	Journal of medical economics [J Med Econ] 2023 Jan-Dec; Vol. 26 (1), pp. 1108-1121.
DOI:	10.1080/13696998.2023.2252716
Abstrakt:	Objective: Nivolumab plus ipilimumab (NIVO + IPI) and pembrolizumab plus axitinib (PEM + AXI) have demonstrated significant clinical benefits as first-line (1 L) treatments for intermediate/poor-risk advanced renal cell carcinoma (aRCC) patients. This study aimed to assess the cost-effectiveness of NIVO + IPI versus PEM + AXI from a Brazilian private healthcare system perspective, utilizing a novel approach to estimate comparative efficacy between the treatments. Methods: A three-state partitioned survival model (progression-free, progressed, and death) was developed to estimate costs, life-years (LYs), quality-adjusted LYs (QALYs), and the incremental cost-utility ratio (ICUR) over a 40-year time horizon. In the absence of head-to-head comparisons between NIVO + IPI and PEM + AXI, clinical data for NIVO + IPI was obtained from CheckMate 214 (NCT02231749) and for PEM + AXI from KEYNOTE-426 (NCT02853331). A matching-adjusted indirect comparison was conducted to account for the imbalance of treatment effect modifiers between the trials. Patient characteristics, resource use, health state utilities, and costs were based on Brazilian-specific sources. Costs and health outcomes were both discounted by 5% annually in line with Brazilian guidelines. The robustness of the results was evaluated through extensive sensitivity analysis and scenario analyses. Results: When comparing the matched versus unmatched OS, PFS, and TTD curves there was no noteworthy difference. NIVO + IPI was associated with cost savings (R$ 350,232), higher LYs (5.54 vs. 4.61), and QALYs (4.74 vs. 3.76) versus PEM + AXI, resulting in NIVO + IPI dominating PEM + AXI. Key model drivers were the treatment duration for PEM, NIVO, and AXI. NIVO + IPI remained dominant in all scenario analyses, which indicated that model results were robust to alternative modelling inputs or assumptions. Conclusions: This analysis shows that NIVO + IPI is estimated to be a life-extending and potentially cost-saving 1 L treatment option when compared with PEM + AXI for intermediate/poor-risk a RCC patients in the Brazilian private healthcare system.
Databáze:	MEDLINE
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