With the growing price of cancer treatment, researchers evaluated the cost-effectiveness of the new standard-of-care in frontline metastatic renal cell carcinoma.
The combination use of Yervoy (ipilimumab) plus Opdivo (nivolumab) was estimated to be cost-effective compared with Sutent (sunitinib) for the treatment of poor- to intermediate-risk patients with renal cell carcinoma (RCC), according to a cost analysis published in JAMA Oncology.
Moreover, the willingness-to-pay threshold ranged from $100,000 to $150,000 per quality-adjusted life-years — which is the generic measure of disease burden, including the quality and quantity of life lived, that is used to assess the value of money for medical interventions.
With its recent Food and Drug Administration approval — which was based on data from the randomized phase 3 CheckMate 214 trial – the combination has become the new first-line standard of care for patients. However, it is unknown if this treatment option is cost effective from the US payer perspective.
“Considering the high cost of nivolumab plus ipilimumab, there is a need to assess its value by considering both efficacy and cost,” the researchers wrote.
The researchers used a model to compare the lifetime costs and effectiveness of Yervoy in combination with Opdivo, which costs $32,213.44 on average, versus Sutent using outcomes data from the CheckMate 214 trial of 1,096 patients with metastatic RCC.
It was estimated that life expectancy of patients in the combination arm was 3.99 years — 1.27 life-years more than those who received Sutent. When the researchers accounted for quality of life, the combination arm gained 2.84 quality-adjusted life-years – 0.96 quality-adjusted life-years more than the Sutent group.
However, combination use of Yervoy plus Opdivo costed an additional $104,072, resulting in $108,363 per quality-adjusted life-years compared with Sutent.
The rate of overall survival did influence the model — highlighting the justification to analyze the cost-effectiveness of the combination in patient subgroups. This analysis demonstrated that patients with PD-L1 status of at least 1% benefitted most for cost-effectiveness at $86,390 per quality-adjusted life-years.
“Pending the development of a reliable PD-L1 assay, this might be one way to use nivolumab plus ipilimumab more cost effectively,” the researchers wrote. “However, from a more far-sighted perspective, the development of a predictive biomarker for both sunitinib and nivolumab plus ipilimumab would allow for the utilization of the least costly regimen for the best responders of both regimens.”
In addition, the model found that combination use of Yervoy plus Opdivo may not be cost-effective for those who weigh more. “However, this brings into question ethical issues of charging obese patients more money for the same life-sustaining treatments,” the researchers noted.
With this, the researchers added that, from a patient perspective, financial toxicity must be taken into consideration when it comes to these expensive treatments. “The high price of anticancer drugs might place individual patients with cancer at risk for serious financial toxicity — the distress caused by the financial burden of out-of-pocket expenses incurred for medical care that is not covered by health insurance,” they wrote. “It has been demonstrated that financial toxicity leads to delay, abandonment and discontinuation of treatment among patients with cancer. For health care systems, ensuring that patients have access to innovative treatment is as important as minimizing financial toxicity.”