Nivolumab plus ipilimumab was deemed cost effective compared with sunitinib in advanced renal cell carcinoma (RCC), according to an analysis published in The Oncologist.1

“Our analysis predicts the combination is likely to be considered cost effective in the United States,” said coauthor Michal Sarfaty, MD, the Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel, in an email interview with Cancer Therapy Advisor. “It has already been adopted by the National Comprehensive Cancer Network guidelines as the standard of care for first-line treatment in intermediate- to poor-risk metastatic kidney cancer patients.”

Previous studies have shown significantly higher overall survival and objective response rates with the immunotherapy combination of nivolumab plus ipilimumab compared with the targeted therapy sunitinib in intermediate- and poor-risk groups.2 The current study sought to examine the cost effectiveness of these 2 drugs versus sunitinib for first-line treatment of advanced RCC.

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Due to sunitinib returning a superior objective response rate and progression-free survival in an exploratory analysis of the favorable-risk RCC group, this group was not included in the full analysis.

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To compare the 2 treatment approaches, Dr Sarfaty and his colleagues developed a Markov model that incorporated data from the CheckMate 214 trial of nivolumab plus ipilimumab versus sunitinib in previously untreated advanced RCC. 2 All patients in the model started at stable disease and either remained there or transitioned to progressive disease or death. The study’s primary outputs were cost and quality-adjusted life-years (QALYs), which were then used to calculate the incremental cost-effectiveness ratio (ICER).

The total cost-per-patient of nivolumab plus ipilimumab was found to be $292,308, compared with $169,287 for sunitinib. Nivolumab plus ipilimumab also generated a gain of 0.978 QALYs over sunitinib; this meant an estimated ICER for nivolumab plus ipilimumab of $125,739/QALY compared with sunitinib.

The willingness-to-pay (WTP) thresholds in the United States typically range from $100,000/QALY to $150,000/QALY for cancer drugs and from $50,000/QALY to $100,000/QALY for noncancer drugs,3 which puts the nivolumab plus ipilimumab combination on the high end of the pricing spectrum.

Another new immunotherapy combination — paclitaxel plus ramucirumab for second-line metastatic gastric cancer — has an estimated ICER of $1,000,000/QALY,4 making the nivolumab plus ipilimumab combination in RCC appear reasonably priced by comparison.