OBJECTIVES

: To assess the cost-effectiveness of cabozantinib compared to nivolumab for patients with advanced renal cell carcinoma (RCC) who progressed after previous vascular endothelial growth factor receptor (VEGFR) tyrosine-kinase inhibitor treatment from a limited societal perspective in South Korea

METHODS

: A partitioned-survival model with three health states, progression free, progressed disease, and death, was developed to compare the costs and effectiveness of cabozantinib and nivolumab over a 30-year time horizon with a cycle length of 28 days. A network meta-analysis was conducted to compare progression-free survival (PFS) and overall survival (OS) outcomes between cabozantinib and nivolumab by using two pivotal clinical trials: METEOR trial and CheckMate025 trial including individual patient level data. This analysis included costs related with medication (cabozantinib 60 mg/day and nivolumab 240 mg/2 weeks), best supportive care, monitoring, adverse events, hospice, transportation to hospitals, and nursing with a micro-costing approach mainly based on national health insurance statistics in Korea. Utility values for health states and adverse events were derived from the results of EQ-5D-5L in METEOR trial by using Korean specific tariff. Univariate and probabilistic sensitivity analyses were conducted to address uncertainties in the model. Incremental cost-effectiveness ratio (ICER) was calculated in 2018 USD currency value using 5% discount rate.

RESULTS

: Cabozantinib was associated with higher costs (5,275 USD), PFS (0.34 years), OS (0.30 years), and QALYs (0.23 QALYs) compared to nivolumab. The ICER was 22,954 USD/QALY gained. In the univariate analysis, medication cost was the most influential factor on the result. According to the Korean gross domestic product per capita (GDP) on 2017 (29,115 USD), cabozantinib had a 57% and 70% probability of being cost-effective at 1*GDP and 2*GDP threshold, respectively.

CONCLUSIONS

: In South Korea, cabozantinib might be a cost-effective treatment option compared to nivolumab for patients with advanced RCC who progressed after previous VEGFR tyrosine-kinase inhibitor treatment.