Cost-effectiveness of pembrolizumab plus axitinib versus sunitinib as first-line therapy in advanced renal-cell carcinoma in the United States.

The data from phase 3 clinical trial KEYNOTE-426 has indicated that pembrolizumab plus axitinib compared to sunitinib could generate clinical benefits in patients with previously untreated advanced renal cell carcinoma (RCC). Given the incremental clinical benefits, we aim to examine the potential cost-effectiveness of pembrolizumab plus axitinib versus sunitinib in the first-line setting for patients with advanced RCC from the United States (US) payers’ perspective.
Cost and health outcomes were estimated at a willingness-to-pay (WTP) threshold of $100,000 to $150,000 per quality adjusted life year (QALY). One-way and probabilistic sensitivity analyses were performed by varying potentially modifiable parameters, and additional subgroup analyses were performed as well.
Upon our analyses, the total treatment costs in the pembrolizumab plus axitinib and sunitinib groups were $522,796 and $348,424, and the QALYs gained 2.90 and 1.72, respectively. In the base-case analysis, compared with receiving sunitinib, advanced RCC patients receiving pembrolizumab plus axitinib gained 1.18 more QALYs at a cost-effectiveness ratio (ICER) of $148,676/QALY. The results of subgroup analyses demonstrated that pembrolizumab plus axitinib was most cost-effective for patients who had one organ with metastasis.
First-line treatment with pembrolizumab plus axitinib, compared to sunitinib, is a cost-effective strategy when the value of WTP is from $100,000 to $150,000 per QALY in advanced RCC patients. For patients with one-organ metastasis and those in poor IMDC risk group, first-line treatment with pembrolizumab plus axitinib is more cost-effective than others.
We performed the first study to examine the cost-effectiveness of pembrolizumab plus axitinib versus sunitinib in advanced RCC. Our study find first-line treatment with pembrolizumab plus axitinib is a cost-effective strategy when the value of WTP is from $100,000 to $150,000 per QALY in advanced RCC patients from the United States payers’ perspective.

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