A Cost-Effectiveness Analysis of Nivolumab Plus Ipilimumab (NIVO+IPI) Vs Pembrolizumab Plus Axitinib (PEM+AXI) for the First-Line Treatment of Intermediate or Poor (I/P)-Risk Advanced Renal Cell Carcinoma Patients in Peru

OBJECTIVES: Immuno-oncology (IO) combination (NIVO+IPI) and IO+tyrosine kinase inhibitor (PEM+AXI) therapies have demonstrated significant clinical benefits over sunitinib in the first-line (1L) treatment of I/P-risk advanced renal cell carcinoma (aRCC). We examined the cost-effectiveness of NIVO+IPI versus PEM+AXI in the 1L aRCC setting from a Peruvian healthcare payer perspective, utilizing a novel approach to estimate comparative efficacy between the treatments.

METHODS: A three-state partitioned survival model (progression-free, progressed, and death) was developed using a 20-year lifetime horizon. Due to the lack of head-to-head clinical evidence between NIVO+IPI and PEM+AXI, a matching-adjusted indirect comparison that accounted for any imbalance in observed treatment effect modifiers was performed. To extrapolate outcomes over a lifetime horizon, a range of parametric survival curves were fitted to the adjusted Kaplan-Meier survival data, which accounted for non-proportional hazards over time. The model used baseline patient characteristics from WHO data, literature, and expert opinion. In the absence of Peruvian EQ-5D-3L tariffs, utilities (EQ-5D-3L) were taken from CheckMate 214 and were calculated using the Argentinian value set. Costs (Sol [S/]; 2023 price) were sourced from Peruvian and Columbian tariff data. Costs and QALYs were discounted by 5.0% annually in line with IETS guidelines. Robustness of the model results was evaluated using deterministic and probabilistic sensitivity analysis, and extensive scenario analyses.

RESULTS: NIVO+IPI was associated with cost savings (S/211,673), higher life-years (5.16 vs 4.42) and quality-adjusted life-years (4.48 vs 3.67) versus PEM+AXI, resulting in NIVO+IPI dominating PEM+AXI. Key model drivers were the treatment duration for PEM, NIVO, and AXI; and utility values for pre- and post-progression. NIVO+IPI remained dominant in all scenario analyses, which indicated that model results were robust to alternative modelling inputs or assumptions.

CONCLUSIONS: NIVO+IPI is estimated to be a life-extending and potentially cost saving 1L treatment option compared with PEM+AXI for I/P-risk aRCC patients in Peru.