COST-EFFECTIVENESS OF NIVOLUMAB IN PATIENTS WITH ADVANCED OR METASTATIC RENAL CELL CARCINOMA IN PORTUGAL
Author(s)
Verleger K1, Almeida AJ2, Verheggen B3, Schoeman O1, Klijn S3, Doan J4, Lees M5, Malcolm B6
1Pharmerit International, Berlin, Germany, 2Bristol-Myers Squibb, Paço de Arcos, Portugal, 3Pharmerit International, Rotterdam, The Netherlands, 4Bristol-Myers Squibb, Wallingford, CT, USA, 5Bristol-Myers Squibb, Princeton, NJ, USA, 6Bristol-Myers Squibb, Middlesex, UK
OBJECTIVES: Recent phase III clinical trial evidence has demonstrated that nivolumab improves overall survival (OS) and health-related quality of life (HRQoL) versus everolimus in advanced renal cell carcinoma (RCC) patients who have received prior therapy. This study aimed to evaluate the cost-effectiveness of nivolumab versus everolimus for the treatment of these patients from a Portuguese societal perspective. METHODS: A validated partitioned survival model with states for progression-free survival (PFS), progressed disease (PD), and death was used to simulate the follow-up of advanced RCC patients. The proportion of patients in each state over time was calculated based on PFS and OS survival data from NCT01668784. PFS and OS data were extrapolated, respectively using a dependent 2-spline hazard model and log-logistic distribution. Adverse events and subsequent treatments were incorporated based on trial data. Drug costs were based on list prices; disease management costs on Portuguese input data and expert panel feedback. Time to treatment discontinuation data from the trial were used to estimate nivolumab drug costs. QoL weights were obtained from within-trial EQ-5D information. The time horizon was 25 years with costs and outcomes discounted 5% annually. Scenario and sensitivity analyses were conducted to assess uncertainty. RESULTS: Compared with the current standard of care in Portugal, everolimus, treatment with nivolumab provided an additional 0.615 quality-adjusted life-years (QALYs), CI: 0.317-0.914 and 0.667 life-years at an incremental cost of € 37,820, CI: € 27,736-44,384. The resulting incremental cost-effectiveness ratio was € 56,667 per QALY. CONCLUSIONS: These economic analysis results demonstrate that although treatment with nivolumab is associated with higher costs of treatment, nivolumab provides significant survival benefits, improved quality-of-life, and a favorable toxicity profile versus everolimus. The ICER results above might be subject to change during negotiations with local authorities. This analysis aims to inform coverage and reimbursement decisions in Portugal.
Conference/Value in Health Info
2016-10, ISPOR Europe 2016, Vienna, Austria
Value in Health, Vol. 19, No. 7 (November 2016)
Code
PCN133
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Oncology