Nivolumab in the Treatment of Metastatic Renal Cell Carcinoma: A Cost-Utility Analysis

Am J Clin Oncol. 2018 Dec;41(12):1235-1242. doi: 10.1097/COC.0000000000000451.

Abstract

Introduction: Nivolumab improves overall survival and health-related quality of life compared with everolimus in metastatic renal cell carcinoma (mRCC). This study assesses the cost-utility of nivolumab from the Canadian health care payer perspective.

Materials and methods: To evaluate the cost-utility of nivolumab, a Markov cohort model that incorporated data from the phase 3 CheckMate-025 trial and other sources was developed. The incremental cost per quality-adjusted life month (QALM) gained for nivolumab was calculated. A lifetime horizon was used in the base-case with costs and outcomes discounted 3% annually. The probabilities of progression and death from cancer and utility values were captured from the CheckMate-025 trial. Expected costs were based on Ontario fees and other sources. Scenario and sensitivity analyses were conducted to assess uncertainty.

Results: Compared with everolimus, nivolumab provided an additional 4.2 QALM at an incremental cost of $34,153. The resulting incremental cost-effectiveness ratio was $8138/QALM gained. Assuming a willingness to pay (WTP) threshold of $4167/QALM ($50,000/quality-adjusted life-year [QALY]), nivolumab was not cost-effective. In 1-way sensitivity analyses, nivolumab cost, median overall survival, and median treatment duration were sensitive to changes. Furthermore, the results were sensitive to the WTP threshold and nivolumab became a cost-effective strategy with a WTP of $8333/QALM ($100,000/QALY).

Conclusions: Compared with everolimus, nivolumab is unlikely to be cost-effective for the treatment of mRCC from a Canadian health care perspective with its current price assuming a WTP of $50,000/QALY. Although mRCC patients derive a meaningful clinical benefit from nivolumab, considerations should be given to avoid drug wastage and increase the WTP threshold to render this strategy more affordable.

MeSH terms

  • Antineoplastic Agents, Immunological / economics*
  • Antineoplastic Agents, Immunological / therapeutic use
  • Canada
  • Carcinoma, Renal Cell / drug therapy
  • Carcinoma, Renal Cell / economics*
  • Carcinoma, Renal Cell / secondary
  • Cohort Studies
  • Cost-Benefit Analysis
  • Follow-Up Studies
  • Humans
  • Kidney Neoplasms / drug therapy
  • Kidney Neoplasms / economics*
  • Kidney Neoplasms / pathology
  • Markov Chains
  • Nivolumab / economics*
  • Nivolumab / therapeutic use
  • Prognosis
  • Quality of Life
  • Survival Rate

Substances

  • Antineoplastic Agents, Immunological
  • Nivolumab