Cost-Utility of Cabonivo vs Sunitinib, Pazopanib and Ipinivo for First Line Advanced Renal-Cell Carcinoma in the Private Healthcare System in Brazil

OBJECTIVES: To assess the cost-utility of cabozantinib + nivolumab (CaboNivo) compared to sunitinib, pazopanib, and ipilimumab + nivolumab (IpiNivo) for patients with advanced renal cell carcinoma (RCC) in first line setting.

METHODS: A partitioned survival model was developed with three health states: progression-free, progressed, and death. Clinical data were obtained from the CheckMate 9ER study (CaboNivo vs sunitinib) and we developed a network meta-analysis for CaboNivo vs other comparators. The costs considered were acquisition of drugs, monitoring of the disease and adverse events. Costs and benefits were discounted at rate of 5%.

RESULTS: The costs in the progression-free state with CaboNivo, IpiNivo, sunitinib and pazopanib were 1.73 million, 1.22 million, 199,278 and 145,701 respectively. In the progressed disease, costs were 965,846, 1.53 million, 2.05 million and 1.99 million, respectively. The total QALY gained with CaboNivo was 4.43, 3.20 with sunitinib, 3.04 with pazopanib. In the intermediate/high risk population (regulatory approval of IpiNivo in Brazil), the total QALY with CaboNivo was 4.87 and 4.61 with IpiNivo. In a 1,000-patient cohort example, at the end of year 1, the number of progression-free patients was 605 patients in the cohort treated with CaboNivo, 459 patients with IpiNivo, 370 patients with sunitinib, and 342 with pazopanib. The ICER of CaboNivo vs sunitinib and pazopanib was BRL 365,591/QALY, BRL 402,944/QALY and vs IpiNivo was BRL 347,698 QALY (intermediate/high risk population). In the probabilistic sensitivity analysis, CaboNivo showed higher clinical benefit and lower cost in 28% of iterations vs IpiNivo.

CONCLUSIONS: CaboNivo was associated with higher clinical benefit and cost vs pazopanib and sunitinib. In the comparison vs IpiNivo, CaboNivo showed higher clinical benefit and in 28% of simulations presented lower cost vs IpiNivo. The model was most sensitive to changes in relative dose intensity, discount rate, acquisition drug costs.