OBJECTIVES: To evaluate the cost-effectiveness of first-line therapy utilizing immune checkpoint inhibitors (ICIs) in renal cell carcinoma (RCC).

METHODS: A scoping review was conducted on PubMed, Embase, and the Cochrane Library databases to identify cost-effectiveness analyses (CEAs) of ICI therapies in RCC published between January 1, 2015, and June 1, 2023. Eligible articles were selected: 1) original research articles, 2) studies with objectives related to CEAs and/or cost-utility analysis, 3) studies focused on the United States, and 4) studies written in English. The characteristics of treatments (e.g., treatment line, class of medication, and cost-effectiveness) and approaches of CEAs (e.g., outcomes, models) were extracted and summarized, and the Quality of Health Economic Studies (QHES) tool was used to evaluate the quality of each article.

RESULTS: Among the 20 included studies, the majority of them addressed advanced clear cell RCC (n = 15), assessed the cost-effectiveness of combination therapies (n = 14), and used a willingness-to-pay threshold of $150,000 per quality-adjusted life year (n = 16). Nivolumab + ipilimumab (n = 4) and pembrolizumab + axitinib (n = 3) were consistently identified as cost-effective first-line options for treating RCC compared to sunitinib. However, nivolumab + cabozantinib was not considered cost-effective compared to sunitinib (n = 2) and cabozantinib (n = 1), with price reductions for nivolumab suggested to achieve that favorable cost-effectiveness. Key factors influencing cost-effectiveness included the cost of treatment therapies, average patient weight, projected disease progression, and patient survival. The QHES scores ranged from 70 to 99 with a mean score of 92.4 (SD = 7.2).

CONCLUSIONS: Several first-line ICC regimens in RCC were found to be cost-effective, including nivolumab + ipilimumab and pembrolizumab + axitinib. ICC prices were identified as the key factor for favorable cost-effectiveness. This information could help guide decision-making among US payers.