OBJECTIVES: Currently there exists a wide range of metastatic renal cell carcinoma (mRCC) treatment schemes, among them cabozantinib, registered in Russia in 2019. The main aim of this study was to perform pharmacoeconomic analysis of using cabozantinib as second-line therapy in mRCC in adult patients in Russia.

METHODS: Analysis of the published clinical trials was conducted to evaluate comparative efficacy and safety of using different types of second-line therapy used in Russia – cabozantinib, nivolumab, axitinib, everolimus. MS Excel based foreign partitioned survival model of medical care patients with mRCC has been adapted for the Russian Healthcare System. The model consisted of three health states: pre-progression, post-progression and death. Outcomes were calculated at each 2-weekly cycle up to a time horizon of 30 years. To measure costs of mRCC treatment with different types of second-line therapy for the state budget were used “cost-effectiveness” and “cost–utility” analysis. Direct medical costs included drugs, therapy monitoring, palliative care. The life-years gained (LYG) and quality adjusted life-years (QALY) were included into the model as the effectiveness criteria.

RESULTS: Efficacy analysis showed the highest rates of LYG (3.18) and QALY (1.87) for cabozanthinib compared with nivolumab (2.53 LYG and 1.6 QALY), axitinib and everolimus (2.21 LYG and 1.31 QALY). Total costs for mRCC patients treated with cabozanthinib were $60273, which is 5 % less than when using nivolumab ($63077). Min total costs were for axitinib ($29436), while its effectiveness was lower compared with the cabozanthinib one. Cost per LYG for cabozantinib was $19624, which is 25 % less compared to those for nivolumab. Cost per QALY for cabozantinib amounted $32239, which is 19 % less than those for nivolumab (rate for July 2020).

CONCLUSIONS: Using cabozantinib as second-line therapy in mRCC in adult patients was effective and economically justified treatment option in Russia.