Objectives: Immunotherapy (IO) has significantly improved survival rates and quality of life in comparison with tyrosine kinase inhibitors for patients with advanced renal cell carcinoma (aRCC). We estimated the economic impact of incorporating IO into the National High-Cost Drug Financing Agency list of reimbursed medications for treating intermediate- and poor-risk aRCC in Uruguay.
Methods: We performed a cost-effectiveness analysis comparing nivolumab plus ipilimumab (intervention) with pembrolizumab plus axitinib (comparator) in intermediate and poor-risk aRCC using a 3-state Markov model. We included deterministic and probabilistic sensitivity analyses. Additionally, we constructed a budget impact model with a 5-year time horizon across intermediate and poor-risk groups.
Results: In the cost-effectiveness analysis base case, nivolumab plus ipilimumab option generated a mean cost savings per treated patient of -$41,864 and a gain of 0.60 and 0.56 in LYs and QALYs, respectively, with an incremental cost-effectiveness ratio of -$74,266.0. After probabilistic sensitivity analysis, the treatment regimen of nivolumab plus ipilimumab showed a 0.88 probability of being dominant compared with pembrolizumab plus axitinib for the treatment of patients with advanced RCC intermediate-poor risk group. In the comparative budget impact model between IO regimens, the cumulative cost for the pembrolizumab plus axitinib option was $80,422 148.5, whereas for nivolumab plus ipilimumab, it was $58,742,374.8, with a decremental difference of $21,679,773.7 in favor of the latter regimen.
Conclusions: Nivolumab plus ipilimumab represents a cost-saving option for first-line aRCC treatment and a cost-effective regimen for patients with intermediate and poor-risk aRCC in Uruguay.
Keywords: advanced renal cell carcinoma (aRCC); budget impact model (BIM); cost-effectiveness analysis (CEA); immunotherapy (IO); nivolumab plus ipilimumab.
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