OBJECTIVES: Immuno-oncology (IO) combination NIVO+IPI and IO+tyrosine kinase inhibitor combination (PEM+AXI) therapies have demonstrated significant clinical benefits over sunitinib in the first-line (1L) treatment of I/P-risk advanced renal cell carcinoma (aRCC). We examined the cost-effectiveness of NIVO+IPI versus PEM+AXI for this from a Colombian payer perspective, utilizing a novel approach to estimate comparative efficacy between the treatments.

METHODS: A three-state partitioned survival model (progression-free, progressed, and death) was developed to estimate costs, life-years (LYs), quality-adjusted LYs (QALYs), and the incremental cost-utility ratio (ICUR) over a 40-year time horizon. Due to the lack of head-to-head clinical evidence between NIVO+IPI and PEM+AXI, a matching-adjusted indirect comparison that accounted for any imbalance in observed treatment effect modifiers was performed. To extrapolate outcomes over a lifetime horizon, a range of parametric survival curves were fitted to the adjusted Kaplan-Meier survival data, which accounted for non-proportional hazards over time. The model used baseline patient characteristics (age, sex, background mortality) from Colombian literature. In the absence of Colombian EQ-5D-3L tariffs, utilities (EQ-5D-3L) were taken from CheckMate 214 and calculated using the Argentinian value set. All costs (2022 COL$) were Colombian-specific where available. Costs and health outcomes were both discounted by 5% annually in line with IETS guidelines. Robustness of the results was evaluated through extensive sensitivity analysis and scenario analyses.

RESULTS: NIVO+IPI was associated with cost savings (COL$ 294,303,933), higher LYs (4.70 vs 4.25) and QALYs (4.08 vs 3.54) versus PEM+AXI, resulting in NIVO+IPI dominating PEM+AXI. Key model drivers were the treatment duration for PEM, NIVO and AXI. NIVO+IPI remained dominant in all scenario analyses, which indicated that model results were robust to alternative modelling inputs or assumptions.

CONCLUSIONS: This analysis shows that NIVO+IPI is estimated to be a life-extending and potentially cost-saving 1L treatment option when compared with PEM+AXI for I/P risk aRCC patients in Colombia.