Cost Effectiveness Analysis of Pembrolizumab for the Treatment of Advanced or Metastatic Renal Cell Carcinoma

OBJECTIVES: Pembrolizumab in combination with axitinib is indicated for first line treatment of patients with advanced or metastatic renal cell carcinoma (RCC) based on results of KEYNOTE-426 trial. The present study aims to assess cost-effectiveness of Pembrolizumab plus axitinib versus sunitinib in Greece.

METHODS: A partitioned survival model with three health states (pre-progression, progressed disease and death) was developed, adopting payer’s perspective with a 39 years’ time-horizon. Clinical, safety and quality of life data were drawn from KEYNOTE-426 trial and via literature review. Primary outcomes were patients’ life years gained (LYG), quality-adjusted life years (QALYs), total costs and incremental cost-effectiveness ratios (ICERs) per LYG and per QALY. Both costs and outcomes were discounted at 3.5% per annum. Α one-way sensitivity analysis was undertaken to examine the most influential parameters on the results and a probabilistic sensitivity analysis (PSA) was conducted to account for uncertainty in the model.

RESULTS:

The model showed that, over a lifetime horizon, total average cost per patient with pembrolizumab and axitinib was estimated at €186,910 whereas the cost of sunitinib was €70,428. Pembrolizumab with axitinib was significantly more effective than sunitinib providing 6.92 LYs versus 3.86 LYG which translated into 5.61 and 3.08 QALY’s respectively; overall incremental LYG were 3.06 and the incremental QALYs were 2.53. The ICER was estimated at €38,089/LYG and €46,085/QALY which is below the national cost effectiveness threshold for Greece. One way sensitivity analysis indicated that the most influential parameters on the model did not change results significantly such as shorter time horizon, and different parametric extrapolations. PSA confirmed the deterministic analysis results, indicating robustness of the results.

CONCLUSIONS: The present study suggests that pembrolizumab in combination with axitinib versus sunitinib is a highly clinical effective intervention that optimizes health outcomes and the efficient allocation of resources invested in cancer in Greece.