The combination of cabozantinib/nivolumab (CaboNivo) was approved in 2021 for the first-line (1L) treatment of adults with advanced renal cell carcinoma (aRCC) based on the results of the CheckMate 9ER trial (NCT03141177). We conducted a cost-effectiveness analysis of CaboNivo versus alternative 1L aRCC therapies.

METHODS:

A global cost-effectiveness model was developed in Microsoft Excel® using a partitioned survival model and deterministic and probabilistic frameworks to estimate treatment-specific effectiveness (life years, quality-adjusted life years [QALYs]) and costs. The model comprised three mutually-exclusive health states: progression free, progressed disease and death. Under a lifetime horizon (50-years), patients entered the model in the progression-free state and received 1L CaboNivo or an alternative tyrosine kinase inhibitor (TKI; cabozantinib, pazopanib, temsirolimus, tivozanib, sorafenib, sunitinib) or combination (axitinib/avelumab, axitinib/pembrolizumab, ipilimumab/nivolumab, lenvatinib/pembrolizumab). Treatment effect estimates (overall survival, progression-free survival) were derived from a network meta-analysis using published data for all treatment alternatives, adjusted for the prognostic profile of the source populations. Following 1L treatment discontinuation (progressed-disease state), patients received subsequent therapy, with treatment distribution derived from clinical studies. Adverse events were incorporated as one-off events during the state associated with cost and utility decrement. Health state utilities were derived from EQ-5D data from the CheckMate 9ER trial. France was used as the base-case.

RESULTS:

CaboNivo’s effectiveness was similar to that of ipilimumab/nivolumab (7.4 life years and 5.4 QALYs for both) and it was more effective than alternative TKIs (life-year range, 5.1–6.2; QALY range, 3.8–4.6) and combinations (life-year range, 6.3–7.1; QALY range, 4.7–5.2). CaboNivo was more costly than all TKI monotherapies (total cost EUR 248,369 vs EUR 54,278–174,112), but similar to other combination approaches (total cost EUR 187,276–387,010).

CONCLUSIONS: CaboNivo had a favourable cost-effectiveness profile compared to other globally available 1L treatment options when using French costs over a lifetime horizon.