Compared with pembrolizumab plus axitinib, nivolumab plus ipilimumab was associated with consistently lower incremental cost per survivor and cost per life-month relative to sunitinib throughout the course of treatment in patients with previously untreated advanced renal cell carcinoma (aRCC), according to research presented at the International Kidney Cancer Symposium (IKCS) 2021.
In the CheckMate 214 (ClinicalTrials.gov Identifier: NCT02231749) and KEYNOTE-426 (ClinicalTrials.gov Identifier: NCT02853331) trials, nivolumab plus ipilimumab and pembrolizumab plus axitinib, respectively, demonstrated survival benefits relative to sunitinib in patients with previously untreated aRCC. To estimate cost efficiency, the investigators compared the cost per survivor and cost per life-month relative to sunitinib for the 2 treatments.
The investigators used a matching-adjusted indirect comparison to derive overall survival (OS) rates of nivolumab plus ipilimumab (CheckMate 214: median follow up, 55 months) and pembrolizumab plus axitinib (KEYNOTE-426: median follow up, 43 months). They calculated monthly incremental cost per survivor for each treatment relative to sunitinib as the difference in monthly costs divided by the difference in OS rates at 12, 24, 36, and 48 months and incremental cost per life-month using a similar approach but with restricted mean survival time. Estimated treatment costs (2020 USD) included costs of drug acquisition, administration, and management of grade 3/4 adverse events.
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The monthly incremental cost per survivor relative to sunitinib for nivolumab plus ipilimumab decreased over time from $90,035 for 12 months to $18,881 for 48 months; and were consistently lower than the cost of pembrolizumab plus axitinib (at 12 months: $90,035 vs $135,461; at 24 months: $26,483 vs $137,105; at 36 months: $26,025 vs $100,889; at 48 months: $18,881 vs $136,342). No clear pattern was identified for monthly incremental cost per survivor relative to sunitinib for pembrolizumab plus axitinib.
Similar results were observed for incremental cost per life-month relative to sunitinib. Nivolumab plus ipilimumab results were consistently lower than those of pembrolizumab plus axitinib throughout follow up (at 12 months: $237,179 vs $255,718; at 24 months: $49,468 vs $163,965; at 36 months, $32,357 vs $115,100; at 48 months: $27,284 vs $90,895). The difference in incremental cost per life-month between the treatments was $63,611 over 48 months.
The main limitations of the study included unobserved or unmeasured cross-trial
differences, potential differences in costs, treatment durations, and average AEs in clinical practice and those in clinical trial populations, and likely underestimation of the total cost due to lack of data for other costs (such as subsequent treatment costs).
The investigators concluded, “[Nivolumab plus ipilimumab] had consistently lower incremental [cost per survivor] and [cost per life-month] (relative to sunitinib) compared with [pembrolizumab plus axitinib] over time, indicating greater cost efficiency for [nivolumab plus ipilimumab] as first-line aRCC treatment.”
Disclosure: This research was funded by Bristol Myers Squibb. Please see the original reference for a full list of authors’ disclosures.
Reference
Huo S, Del Tejo V, Du EX, Wu A, Chin A, Betts KA. Cost per survivor (CPS) and cost per life-month (CPLM) of nivolumab plus ipilimumab (NIVO+IPI) versus pembrolizumab plus axitinib (PEMBRO+AXI) for previously untreated advanced renal cell carcinoma (aRCC). Presented at IKCS 2021; November 5-6, 2021. Abstract N25.
