The Second Xiangya Hospital and team demonstrated 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 afflicted with renal cell carcinoma (RCC). The Chinese-driven cost analysis was published in JAMA Oncology.
A willingness-to-pay threshold of $100,000 to $150,000 per quality adjusted life years—a generic measure of disease burden, including quality and quantity of life saved, is used to evaluate the value of money for medical treatments.
The duo, recently approved by the FDA was based on data from phase 3 CheckMate 214 trial— the combination became the new first-line standard of care for patients. The Chinese researchers posited that it is unknown if the option reflects a cost effective option for the U.S. payer market.
The researchers articulated that “considering the high cost of nivolumab plus ipilimumab, there is a need to assess its value by considering both efficacy and cost. The researchers used a model to compare the lifetime costs and effectiveness of Yervoy in combination with Opdivo, which adds up to $32,213.44 on average versus Sutent using outcomes data from 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 greater than the data associated with Sutent. Accounting for quality of life, the combined arm increased quality-adjusted life years–.96 quality adjusted years more than the Sutent group.
But when combining Yervoy and Opdivo an addition $104,072, equaling $108,363 per quality adjusted life years compared to Sutent. Investigators reported that patients with PD-L1 status of at least 1% benefitted most for cost-effectiveness at $86, 390 per quality adjusted years.
Researchers noted “for a more far-sighted perspective, a biomarker for both sunitinib and nivolumab plus ipilimumab would allow for utilization of the least costly regimen for the best responders of both regimens.”
Cancer drugs become ever more expensive especially from the middle class patient perspective—“financial toxicity must be taken into consideration when it comes to these expensive treatments.”
For health care systems, ensuring that patients have access to innovative treatment is as important as minimizing financial toxicity.
XiaoMin Wan, PhD, Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
YuCong Zhang, BS, Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
ChongQing Tan, PhD, Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
LiuBao Peng, BS, Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
Other institutions involved:
Institute of Clinical Pharmacy, Central South University, Changsha Human Cina
The PET-CT Center, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China