Cost-Effectiveness of Nivolumab Plus Ipilimumab for the First-Line Treatment of Intermediate/Poor-Risk Advanced and/or Metastatic Renal Cell Carcinoma in Switzerland

Esra Çakar; César Oniangue-Ndza; Ralph P Schneider; Sven L Klijn; Ursula M Vogl; Christian Rothermundt; Jessica R May

doi:10.1007/s41669-023-00395-1

Cost-Effectiveness of Nivolumab Plus Ipilimumab for the First-Line Treatment of Intermediate/Poor-Risk Advanced and/or Metastatic Renal Cell Carcinoma in Switzerland

Pharmacoecon Open. 2023 Jul;7(4):567-577. doi: 10.1007/s41669-023-00395-1. Epub 2023 Feb 9.

Authors

Esra Çakar¹, César Oniangue-Ndza², Ralph P Schneider³, Sven L Klijn⁴, Ursula M Vogl⁵, Christian Rothermundt⁶, Jessica R May⁷

Affiliations

¹ OPEN Health, Rotterdam, The Netherlands.
² Bristol Myers Squibb SA, Hinterbergstrasse 16, 6330, Steinhausen, Switzerland. cesar.oniangue-ndza@bms.com.
³ Bristol Myers Squibb SA, Hinterbergstrasse 16, 6330, Steinhausen, Switzerland.
⁴ Bristol Myers Squibb, Princeton, NJ, USA.
⁵ Istituto Oncologico della Svizzera Italiana (IOSI), Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland.
⁶ Klinik für Medizinische Onkologie und Hämatologie, Kantonsspital St. Gallen, St. Gallen, Switzerland.
⁷ Bristol Myers Squibb, Uxbridge, UK.

Abstract

Objective: This study assessed the cost-effectiveness of nivolumab plus ipilimumab versus both sunitinib and pazopanib for the treatment of first-line unresectable advanced renal cell carcinoma (aRCC) from a healthcare system perspective in Switzerland.

Methods: A three-state partitioned survival model, consisting of progression-free, progressed disease, and death, was constructed. Efficacy estimates were based on data from the CheckMate 214 trial (NCT02231749) with a minimum follow-up of 42 months. Two Swiss oncologists were consulted to determine disease management resource use. Costs were derived from the Swiss tariff lists for outpatient (TARMED Online Browser 1.09) and inpatient (2020 data from Swiss diagnosis-related groups) treatments. Drug acquisition costs (ex-factory prices) were obtained from the March 2020 price list published by the Swiss Federal Office of Public Health. Treatment-specific EQ-5D-3L-based utilities were derived from CheckMate 214 using a French value set as a proxy for Switzerland. The model utilized a 1-week cycle length and a 40-year time horizon, with costs and effects discounted by 3.0% per annum. One-way sensitivity analyses, probabilistic analysis, and scenario analyses assessed the robustness of the results.

Results: Nivolumab plus ipilimumab yielded incremental 1.43 life-years and 1.36 lifetime discounted quality-adjusted life-years (QALYs) relative to sunitinib and pazopanib at an additional cost of 147,453 Swiss Francs (CHF) and CHF145,643, respectively. With an incremental cost-utility ratio of CHF108,326 per QALY gained versus sunitinib, and CHF106,996 per QALY gained versus pazopanib, the nivolumab plus ipilimumab combination can be considered a cost-effective option for the treatment of patients with aRCC in Switzerland, with a willingness-to-pay threshold of CHF200,000. Sensitivity and scenario analyses confirmed the robustness of the deterministic results.

Conclusions: This study showed that nivolumab plus ipilimumab, which represents one of the standard-of-care first-line treatments for intermediate- or poor-risk aRCC patients, is a life-extending and cost-effective treatment option for patients in Switzerland.