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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 25 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 22 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
  1. QALY quality-adjusted life year, ICER incremental cost-effectiveness ratio, WTP willingness to pay (threshold); nivo, nivolumab; evero, everolimus, RCC renal cell carcinoma; PS, partitioned survival, CE cost-effective
  2. aAll studies consisted of three basic health states (progression-free (stable), progressive disease, and death); all studies performed sensitivity analyses in addition to the base case. No study evaluated programmed cell death ligand-1 status