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首页> 外文期刊>Experimental Hematology Oncology >Cost-effectiveness of nivolumab in patients with advanced renal cell carcinoma treated in the United States
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Cost-effectiveness of nivolumab in patients with advanced renal cell carcinoma treated in the United States

机译：在美国治疗晚期肾细胞癌患者中Nivolumab的成本效益

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We evaluated the cost-effectiveness of nivolumab versus everolimus in patients with advanced renal cell carcinoma (RCC) from a US payer perspective. A partitioned survival model consisting of three health states, progression-free survival (PFS), progressive disease, and death, was developed to evaluate the cost-effectiveness of intravenous nivolumab versus oral everolimus over a lifetime. The proportion of patients in each state was calculated based on parametric distributions fitted to PFS and overall survival (OS) data from CheckMate 025 (N?=?821), a large randomized phase 3 trial of nivolumab versus everolimus for advanced RCC. Health state utility data were derived from CheckMate 025 EQ-5D data. Scenario analyses and deterministic and probabilistic sensitivity analyses assessed the impact of uncertainty in model inputs on outcomes. Over a 25-year lifetime horizon, treatment with nivolumab resulted in a gain of 0.64 quality-adjusted life-years (QALYs) versus everolimus. Nivolumab had greater total costs versus everolimus ($US197,089 vs. $US163,902), mainly due to higher acquisition costs. The incremental cost-utility ratio (ICUR), a measure of incremental costs divided by incremental QALYs, was $US51,714 per QALY gained for nivolumab versus everolimus, and an incremental cost-effectiveness ratio was $US44,576 per life-year gained for nivolumab versus everolimus. In sensitivity analyses, average body weight had the greatest impact on the ICUR for nivolumab versus everolimus (base case $US51,714; range $US8863-$US94,566). At a $US150,000 willingness-to-pay (WTP) threshold, nivolumab had a 91.7% probability of being cost-effective versus everolimus. In the United States, at a WTP threshold of $US150,000 per QALY, nivolumab was found to be cost-effective. Key drivers of cost-effectiveness were survival inputs for OS and the average weight of patients; the latter directly affects nivolumab drug acquisition cost.
机译：从美国付款人的角度来看，我们评估了Nivolumab与血症患者患者患者的成本效益。开发了一种由三种健康状态，无进展生存（PFS），进展性疾病和死亡的分区存活模型，以评估静脉内Nivolumab与口服血管司的成本效益。基于调用PFS的参数分布和来自Checkmate 025的总存活（OS）数据的参数分布来计算每种状态的比例（N？= 821），这是一种大型随机阶段3试验，对Nivolumab对Everolimus进行高级RCC。卫生状态实用程序从CheckMate 025 EQ-5D数据中获取。场景分析和确定性和概率敏感性分析评估了不确定性在模型投入中的影响。在25年的终身视野中，用Nivolumab治疗导致了0.64质量调整的生命年龄（Qalys）与everolimus的增益。 Nivolumab与everolimus的总成本更高（US197,089 VS. $ US163,902），主要是由于收购成本更高。增量成本 - 实用比（ICUR），增加的增量成本率为增量QALYS，为脑病患者对血症患者获得的每种脑癌为51,714美元，均年度成本效益比为每年获得的百分比为44,576美元对于Nivolumab与everolimus。在敏感性分析中，平均体重对Nivolumab的ICUR产生了最大的影响与everolimus（基本案例$ US51,714;范围US8863- $ US94,566）。在100,000美元的愿意支付（WTP）阈值，Nivolumab有91.7％的经济高效率与everolimus。在美国，在每QALY的WTP阈值为150,000美元，发现Nivolumab是具有成本效益的。成本效益的关键驱动因素是OS的存活投入和患者的平均重量;后者直接影响Nivolumab药物收购成本。

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