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

Immunotherapy. 2020 Jan;12(1):37-51. doi: 10.2217/imt-2019-0199. Epub 2020 Jan 29.


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.

Trial registration: NCT02231749 NCT01668784.

Keywords: cost–effectiveness; immuno-oncology therapy; renal cell carcinoma; survival; treatment sequences; treatment-free interval.

Publication types

  • Clinical Trial, Phase II
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antineoplastic Agents, Immunological / therapeutic use*
  • Antineoplastic Protocols
  • Carcinoma, Renal Cell / drug therapy*
  • Carcinoma, Renal Cell / economics
  • Carcinoma, Renal Cell / mortality
  • Computer Simulation*
  • Cost-Benefit Analysis
  • Drug Therapy, Combination
  • Humans
  • Ipilimumab / therapeutic use*
  • Kidney Neoplasms / drug therapy*
  • Kidney Neoplasms / economics
  • Kidney Neoplasms / mortality
  • Models, Economic
  • Neoplasm Staging
  • Nivolumab / therapeutic use*
  • Quality-Adjusted Life Years
  • Survival Analysis
  • Treatment Outcome


  • Antineoplastic Agents, Immunological
  • Ipilimumab
  • Nivolumab

Associated data