OBJECTIVES

: Nivolumab+ipilimumab demonstrated significant improvements in overall survival and objective response with a more favorable tolerability profile compared with sunitinib in the CheckMate-214 study (CM-214; NCT02231749) for untreated patients with intermediate-/poor-risk advanced and/or metastatic renal cell carcinoma (1L RCC). This analysis estimated the cost of grade 3-4 adverse events (AE) for nivolumab+ipilimumab compared with sunitinib among intermediate-/poor-risk 1L RCC patients in Switzerland.

METHODS

: Grade 3-4 AEs frequencies were based on patient-level data for 839 treated intermediate-/poor-risk patients (nivolumab+ipilimumab: N=423; sunitinib: N=416) from CM-214. AE unit costs (in 2019 CHF) were obtained from the Swiss pricing system for inpatient treatment (Swiss DRG 2019). Per-patient treatment-related grade 3-4 AE costs during the first, second, and third year post-treatment were calculated. A sensitivity analysis estimated per-patient all-cause grade 3-4 AE costs.

RESULTS

: The 3 most frequent treatment-related non-laboratory grade 3-4 AEs were fatigue (4.0%), diarrhea (3.5%), and hypophysitis (2.8%) in the nivolumab+ipilimumab arm and hypertension (14.7%), fatigue (8.4%), and palmar-plantar erythrodysesthesia syndrome (7.7%) in the sunitinib arm. Patients treated by nivolumab+ipilimumab had fewer total treatment-related grade 3-4 AEs (n=events; year 1: 399 vs. 602; year 2: 458 vs. 708; year 3: 473 vs. 753) and lower per-patient grade 3-4 AE costs (year 1: 5,662CHF vs. 9,052CHF; year 2: 6,530CHF vs. 10,751CHF; year 3: 6,760CHF vs. 11,469CHF) compared to sunitinib. In the sensitivity analysis, nivolumab+ipilimumab was associated with lower per-patient all-cause grade 3-4 AE costs compared to sunitinib (year 1: 10,424CHF vs. 13,627CHF; year 2: 12,353CHF vs. 16,101CHF; year 3: 12,966CHF vs. 17,084CHF).

CONCLUSIONS

: Nivolumab+ipilimumab offered patients greater efficacy and fewer grade 3-4 AEs than did sunitinib, based on CM-214. When applied to a Swiss setting, nivolumab+ipilimumab was associated with 37.5%-41.1% lower treatment-related grade 3-4 AE costs and 23.3%-24.1% lower all-cause grade 3-4 AE costs compared to sunitinib in patients with intermediate-/poor-risk 1L RCC.