Pembrolizumab plus axitinib and nivolumab plus ipilimumab as first-line treatments of advanced intermediate- or poor-risk renal-cell carcinoma: a number needed to treat analysis from the Brazilian private perspective

Considering clinical benefits of new combination therapies for metastatic renal-cell carcinoma (mRCC), this study aims to calculate the number needed to treat (NTT) and the cost of preventing an event (COPE) for pembrolizumab plus axitinib (P + A), and nivolumab plus ipilimumab (N + I) as first-line...

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Bibliographic Details
Published in:	Journal of medical economics Vol. 24; no. 1; p. 291
Main Authors:	Engel Ayer Botrel, Tobias, Datz Abadi, Márcia, Chabrol Haas, Laura, da Veiga, Cássia Rita Pereira, de Vasconcelos Ferreira, Dominihemberg, Jardim, Denis Leonardo
Format:	Journal Article
Language:	English
Published:	England 01-01-2021
Subjects:	Adult Aged Aged, 80 and over Antibodies, Monoclonal, Humanized - economics Antibodies, Monoclonal, Humanized - therapeutic use Antineoplastic Agents, Immunological - adverse effects Antineoplastic Agents, Immunological - economics Antineoplastic Agents, Immunological - therapeutic use Antineoplastic Combined Chemotherapy Protocols - adverse effects Antineoplastic Combined Chemotherapy Protocols - economics Antineoplastic Combined Chemotherapy Protocols - therapeutic use Axitinib - economics Axitinib - therapeutic use Brazil Carcinoma, Renal Cell - drug therapy Carcinoma, Renal Cell - pathology Cost-Benefit Analysis Female Health Expenditures - statistics & numerical data Health Resources - economics Health Resources - statistics & numerical data Humans Ipilimumab - economics Ipilimumab - therapeutic use Kidney Neoplasms - drug therapy Kidney Neoplasms - pathology Male Middle Aged Models, Economic Nivolumab - economics Nivolumab - therapeutic use Progression-Free Survival Severity of Illness Index Sunitinib - economics Sunitinib - therapeutic use Young Adult Brazil adenocarcinoma, clear cell pembrolizumab D6 D7 costs and cost analysis nivolumab ipilimumab numbers needed to treat D70 Carcinoma, renal cell D61 axitinib
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Summary:	Considering clinical benefits of new combination therapies for metastatic renal-cell carcinoma (mRCC), this study aims to calculate the number needed to treat (NTT) and the cost of preventing an event (COPE) for pembrolizumab plus axitinib (P + A), and nivolumab plus ipilimumab (N + I) as first-line treatments, from the Brazilian private perspective. Overall survival (OS) and progression-free survival (PFS) data for intermediate- and poor-risk groups were obtained from KEYNOTE-426 and CHECKMATE-214 trials for P + A and N + I, respectively, versus sunitinib as mRCC first-line treatment. Considering a 12-month time horizon, 6 patients should be treated with P + A to prevent one death with sunitinib use, resulting in a COPE of 3,773,865 BRL. Using N + I, NNT for 12-month OS rate was 13 compared to sunitinib, with a COPE of 6,357,965 BRL. Regarding PFS data, NNT was also 6 when comparing P + A versus sunitinib, with an estimated COPE of 3,773,865 BRL. Estimated NNT was 20 comparing N + I and sunitinib, resulting in a COPE of 10,172,744 BRL. Cost differences between two treatment options, reached more than 6 million BRL for PFS, and 2 million BRL for OS. At the 12-month landmark, P + A suggests better economic scenario versus N + I as first-line mRCC treatment option for intermediate- and poor-risk groups, through an indirect comparison using sunitinib as a common comparator.
ISSN:	1941-837X
DOI:	10.1080/13696998.2021.1883034