Objective

To estimate the cost-effectiveness and value of information of cabozantinib compared to nivolumab in advanced renal cell carcinoma (RCC) patients, who previously failed treatment from a societal perspective in South Korea.

Methods

A partitioned survival model was used to evaluate the incremental cost-utility ratio (ICUR) of cabozantinib versus nivolumab. Overall survival (OS) and progression-free survival (PFS) curves were obtained from a network meta-analysis that included METEOR and CheckMate 025 trial results. Utility values for health states and adverse events were estimated based on the EQ-5D-5L data of METEOR trial with a Korean-specific tariff. Costs were estimated by a micro-costing approach using healthcare claims data and expert consultation. The impact of uncertainties in the model were explored by scenario analyses, and deterministic and probabilistic sensitivity analyses. The expected value of perfect information (EVPI) was estimated to assess the value of future research to decrease decision uncertainty.

Results

Compared to nivolumab, cabozantinib was associated with improved OS, PFS, and quality-adjusted life-years (QALYs) at greater cost. The ICUR was $34,445 per QALY. In sensitivity analysis, drug costs had the greatest influence on the ICUR. Cabozantinib had a 68.0% probability of being cost-effective at a threshold of 2 times gross domestic product (GDP) per capita. The population EVPI was $82.6 million at 2 GDP threshold.

Conclusions

Cabozantinib was found to be cost-effective for advanced RCC patients after failure of prior therapy at a 2 GDP threshold. Future research that costs less than the estimated population EVPI would be worth considering for a comparison of cabozantinib and nivolumab.

中文翻译：

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卡博替尼治疗韩国既往治疗失败后晚期肾细胞癌患者的成本效益和信息价值

客观的

评估卡博替尼与纳武单抗相比，在韩国之前治疗失败的晚期肾细胞癌 (RCC) 患者中的成本效益和信息价值。

方法

使用分区生存模型来评估卡博替尼与纳武单抗的增量成本效用比 (ICUR)。总生存期 (OS) 和无进展生存期 (PFS) 曲线来自网络荟萃分析，其中包括 METEOR 和 CheckMate 025 试验结果。基于韩国特定关税的 METEOR 试验的 EQ-5D-5L 数据估计了健康状况和不良事件的效用值。成本是通过使用医疗保健索赔数据和专家咨询的微观成本计算方法估算的。通过情景分析以及确定性和概率敏感性分析，探索了模型中不确定性的影响。估计完美信息的期望值 (EVPI) 以评估未来研究的价值，以减少决策的不确定性。

结果

与纳武单抗相比，卡博替尼以更高的成本与改善的 OS、PFS 和质量调整生命年 (QALY) 相关。ICUR 为每个 QALY 34,445 美元。在敏感性分析中，药物成本对 ICUR 的影响最大。卡博替尼在人均国内生产总值 (GDP) 的 2 倍阈值下具有成本效益的可能性为 68.0%。在 2 GDP 阈值下，人口 EVPI 为 8260 万美元。

结论

在 2 GDP 阈值下，先前治疗失败后发现卡博替尼对晚期 RCC 患者具有成本效益。未来在比较卡博替尼和纳武单抗时，成本低于估计人群 EVPI 的研究值得考虑。