Table 3 Details regarding cost-effectiveness studies of genitourinary cancers
From: A systematic review of the cost and cost-effectiveness studies of immune checkpoint inhibitors
Reference, Country, Year | Comparison | Methodologya | Costs | QALYs | ICER | WTP | Conclusions | Criticisms |
|---|---|---|---|---|---|---|---|---|
Wan et al., USA, 2017 [33] | Nivo vs evero for recurrent RCC | PS; accounted for toxicity and administration costs | $211,407 nivo, $167,405 evero | 1.79 nivo, 1.5 evero | Relative to evero, nivo $151,676/QALY | $100,000/QALY | Nivo not CE in this setting | - Overall modeling horizon of 20 years, when low numbers of patients still alive, causing errors in survival extrapolation and thus costs - Only grade ≥ 3 toxicities (n = 3) accounted for, as a one-time cost - Lack of accountability for hospice/palliative care and death costs |
McCrea et al., USA, 2018 [34] | Nivo vs evero for recurrent RCC | PS; accounted for toxicity, administration, follow-up, and end-of-life costs | $197,089 nivo, $163,902 evero | 2.79 nivo, 2.15 evero | Relative to evero, nivo $51,714/QALY | $150,000/QALY | Nivo is CE in this setting | - Overall modeling horizon of 25Â years, when exceedingly low numbers of patients still alive, causing errors in survival extrapolation and thus costs - Uncertainty of whether proportion of patients treated past time of progression - Assumed non-progressors at 22Â months had same utility as responders |
Sarfaty et al., USA, 2018 [35] | Nivo vs evero vs placebo for recurrent RCC | Markov; accounted for toxicity and administration costs | $101,070 nivo, $50,935 evero | Nivo 0.34 QALYs higher than evero/placebo | Relative to evero, nivo $146,532/QALY; relative to placebo, nivo $226,197/QALY | $100–150,000/QALY | Nivo not CE over placebo, but cost-effectiveness vs. evero depends on particular WTP | - Overall modeling horizon of 10 years, when low numbers of patients still alive, causing errors in survival extrapolation and thus costs - Only grade ≥ 3 toxicities accounted for, as a one-time cost - Lack of accountability for hospice/palliative care and death costs |
Sarfaty et al., USA, 2018 [35] | Pembro vs taxanes for recurrent bladder cancer | Markov; accounted for toxicity and administration costs | Cost of pembro $44,325 higher than taxanes | Pembro 0.36 QALYs higher than taxanes | Relative to taxanes, pembro $122,557/QALY | $100–150,000/QALY | Cost-effectiveness of pembro depends on particular WTP | - Lack of accountability for patients receiving taxanes that subsequently undergo pembro - Only grade ≥ 3 toxicities accounted for, as a one-time cost - Lack of accountability for hospice/palliative care and death costs |