OBJECTIVES: The CheckMate 214 clinical trial showed promising survival results for nivolumab plus ipilimumab (NIVO+IPI) compared with sunitinib in untreated advanced or metastatic renal cell carcinoma (1L RCC). The objective of this study was to assess the cost-effectiveness of NIVO+IPI in 1L RCC compared with other currently available first-line treatments (sunitinib, pazopanib, bevacizumab plus interferon-alpha [BEV+IFN], cabozantinib and temsirolimus) from a payer perspective in Greece.

METHODS: A partitioned survival model with a 20-year time horizon and one-week cycle length was developed. The population of interest was restricted to patients with intermediate to poor prognosis. The model used progression-free survival, time to treatment discontinuation and overall survival data for NIVO+IPI and sunitinib from CheckMate 214. Relative efficacy versus all other comparators was based on the results of a network meta-analysis. Adverse event rates were based on the individual pivotal studies.

Treatment-specific utility values were derived from CheckMate 214. Greek costs for drug acquisition, drug administration, monitoring, subsequent therapies and adverse events were sourced from published prices, literature review and clinical expert input. Input parameters were varied in sensitivity analyses.

Outcomes of interest were total costs, quality-adjusted life-years (QALYs), life years (LYs), the incremental cost-utility ratio (ICUR), and incremental cost-effectiveness ratio (ICER).

RESULTS: NIVO+IPI was associated with the highest number of QALYs and LYs gained versus all comparators. NIVO+IPI ICURs and ICERs were respectively €32,209 and €29,709 versus sunitinib, €14,323 and €15,740 versus pazopanib, €11,025 and €9,701 versus BEV+IFN and €22,785 and €21,789 versus temsirolimus. Cabozantinib was dominated by NIVO+IPI. In scenario analyses the ICURs and ICERs remained below two times the Greek gross domestic product (GDP) per capita (€48,500).

CONCLUSIONS: NIVO+IPI was found to be cost-effective versus all other treatments at a willingness-to-pay threshold of less than two times the GDP per capita in Greece.