COST-EFFECTIVENESS ANALYSIS OF AXITINIB PLUS AVELUMAB AS FIRST-LINE TREATMENT FOR ADVANCED RENAL CELL CARCINOMA
Author(s)
Mao Yamaguchi1, Kaho Komura2, Ryutaro Sakai3, Seiya Taniguchi3, Kensuke Moriwaki, BS, MS, PhD4.
1Student, Ritsumeikan university, Kusatsu, Japan, 2Ritsumeikan University, Japan, 3Ritsumeikan University, Kusatsu, Japan, 4Ritsumeikan University, Kyoto, Japan.
1Student, Ritsumeikan university, Kusatsu, Japan, 2Ritsumeikan University, Japan, 3Ritsumeikan University, Kusatsu, Japan, 4Ritsumeikan University, Kyoto, Japan.
OBJECTIVES: This study aimed to evaluate the cost-effectiveness of axitinib plus avelumab as first-line treatment for advanced renal cell carcinoma from the perspective of the Japanese public healthcare payer.
METHODS: A partitioned survival analysis (PartSA) model was developed to estimate costs and quality-adjusted life years (QALYs) for the axitinib plus avelumab group and the sunitinib group. Survival data were obtained from the JAVELIN Renal 101 trial. Drug costs were calculated based on Japanese drug prices, and other cost parameters were estimated using statistical analyses of the JMDC claims database. A lifetime horizon was applied, and both future costs and health outcomes were discounted at an annual rate of 2%. Utility values were derived from previous studies. The incremental cost-effectiveness ratio (ICER), defined as incremental cost divided by incremental QALYs, was calculated for axitinib plus avelumab compared with sunitinib. Sensitivity analyses were conducted to evaluate uncertainty in model parameters.
RESULTS: Compared with sunitinib, axitinib plus avelumab incurred an additional cost of JPY 49,393,787 and achieved an incremental gain of 0.60 QALYs. The resulting ICER was JPY 83,013,544 per QALY gained. Sensitivity analyses showed that the utility value for the progression-free state in the sunitinib group had the greatest impact on the ICER. Across all sensitivity analyses, the ICER remained substantially above the willingness-to-pay threshold of JPY 15 million/QALY commonly used in Japan. Probabilistic sensitivity analysis demonstrated that the probability of axitinib plus avelumab being cost-effective at this threshold was 0%.
CONCLUSIONS: Axitinib plus avelumab was not cost-effective compared with sunitinib as first-line treatment for advanced renal cell carcinoma under the Japanese willingness-to-pay threshold. These findings suggest that the high drug costs of combination immunotherapy may impose a substantial economic burden on the Japanese healthcare system.
METHODS: A partitioned survival analysis (PartSA) model was developed to estimate costs and quality-adjusted life years (QALYs) for the axitinib plus avelumab group and the sunitinib group. Survival data were obtained from the JAVELIN Renal 101 trial. Drug costs were calculated based on Japanese drug prices, and other cost parameters were estimated using statistical analyses of the JMDC claims database. A lifetime horizon was applied, and both future costs and health outcomes were discounted at an annual rate of 2%. Utility values were derived from previous studies. The incremental cost-effectiveness ratio (ICER), defined as incremental cost divided by incremental QALYs, was calculated for axitinib plus avelumab compared with sunitinib. Sensitivity analyses were conducted to evaluate uncertainty in model parameters.
RESULTS: Compared with sunitinib, axitinib plus avelumab incurred an additional cost of JPY 49,393,787 and achieved an incremental gain of 0.60 QALYs. The resulting ICER was JPY 83,013,544 per QALY gained. Sensitivity analyses showed that the utility value for the progression-free state in the sunitinib group had the greatest impact on the ICER. Across all sensitivity analyses, the ICER remained substantially above the willingness-to-pay threshold of JPY 15 million/QALY commonly used in Japan. Probabilistic sensitivity analysis demonstrated that the probability of axitinib plus avelumab being cost-effective at this threshold was 0%.
CONCLUSIONS: Axitinib plus avelumab was not cost-effective compared with sunitinib as first-line treatment for advanced renal cell carcinoma under the Japanese willingness-to-pay threshold. These findings suggest that the high drug costs of combination immunotherapy may impose a substantial economic burden on the Japanese healthcare system.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
EE61
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Oncology