Clinical and economic outcomes of treatment sequences for intermediate- to poor-risk advanced renal cell carcinoma.

Aim: To assess the cost-effectiveness of treatment sequences for patients with intermediate- to poor-risk advanced renal cell carcinoma. Patients & methods: A discrete event simulation model was developed to estimate patients' lifetime costs and survival. Efficacy inputs were derived from the CheckMate 214 and CheckMate 025 studies and network meta-analyses. Safety and cost data were obtained from the published literature. Results: The estimated average quality-adjusted life-years (QALYs) gained was the highest on nivolumab + ipilimumab-initiated sequences (3.6-5.3 QALYs) versus tyrosine kinase inhibitor (TKI)-initiated sequences (2.1-3.7 QALYs). Incremental cost per QALY gained for nivolumab + ipilimumab-initiated sequences was below the willingness-to-pay threshold of $150,000 versus other sequences. Conclusion: Immuno-oncology combination therapy followed by TKIs is cost-effective versus TKI sequences followed by immuno-oncology or sequencing TKIs.

Immunotherapy. 2020 Jan 29 [Epub ahead of print]

Apoorva Ambavane, Shuo Yang, Michael B Atkins, Sumati Rao, Anshul Shah, Meredith M Regan, David F McDermott, M Dror Michaelson

Evidence Synthesis, Modeling, & Communications, Evidera, Inc., Bethesda, MD 20814, USA., Health Economics Outcomes Research, Bristol-Myers Squibb, Princeton, NJ 08540, USA., Department of Internal Medicine - Medical Oncology, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC 20007-2113, USA., Evidence Synthesis, Modeling, & Communications, Evidera, Inc., Waltham, MA 20814, USA., Division of Biostatistics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA., Department of Medicine, Beth Israel Deaconess Medical Center, Dana-Farber/Harvard Cancer Center, Boston, MA 02215, USA., Massachusetts General Hospital Cancer Center, Boston, MA 02214, USA.