Pembrolizumab plus axitinib is associated with greater quality-adjusted life-years (QALYs) compared with nivolumab plus ipilimumab for patients with advanced renal cell carcinoma (RCC), but may not be cost-effective, according to an economic evaluation published in JAMA Network Open (2020;3[10]:e2016144. doi:10.1001/jamanetworkopen.2020.16144).
“Pembrolizumab-axitinib and nivolumab-ipilimumab have become standard of care options after demonstrating clinical efficacy against sunitinib in separate phase 3 trials,” wrote Tina R Watson, BA, Institute for Technology Assessment, Massachusetts General Hospital, Boston, and colleagues, adding that the cost-effectiveness of these regimens is unknown.
This economic evaluation used a microsimulation model to compare the cost-effectiveness of pembrolizumab-axitinib and nivolumab-ipilimumab. Because prognosis differ between risk groups, separate analyses were conducted for an intermediate- and poor-risk patient population and a favorable-risk population.
Survival, treatment regimens, and other relevant conditions were based on data from the KEYNOTE-426 and CheckMate214 clinical trials. The study was conducted from a US health care sector perspective.
Compared with nivolumab-ipilimumab, pembrolizumab-axitinib was estimated to add 0.60 QALYs for intermediate- and poor-risk patients and 0.25 QALYs for favorable-risk patients, researchers reported. However, pembrolizumab-axitinib was also more expensive, costing an additional $103,966 for intermediate- and poor-risk patients and $118,632 for favorable-risk patients.
Pembrolizumab-axitinib yielded an incremental cost-effectiveness ratio of $172,532 per QALY for intermediate- and poor-risk patients, the study found, and $468,682 per QALY for favorable-risk patients.
“The findings suggest that pembrolizumab-axitinib treatment is associated with greater QALYs compared with nivolumab/ipilimumab treatment in patients with advanced renal cell carcinoma but may not be cost-effective,” Ms Watson and colleagues concluded.
“Price reductions may make the cost of pembrolizumab-axitinib proportional to its clinical value and less financially burdensome to the US health care system,” they added. —Jolynn Tumolo
