OBJECTIVES: Advanced renal cell carcinoma (aRCC) is an incurable cancer with palliative treatment goals, emphasizing the extension of progression-free survival. Tivozanib and sorafenib are approved for aRCC treatment. This analysis assesses the cost-effectiveness of tivozanib and sorafenib for aRCC patients from a US commercial payer perspective.

METHODS: A 3-state partitioned survival model with a 1-month cycle length was used to project the probabilities of progression free survival, overall survival, and death over a lifetime horizon using TIVO-3 trial data. Cost and utility data, discounted at 3 percent annually, were sourced from published literature, databases, and government estimates. Cost inputs included the wholesale acquisition cost of tivozanib ($36,800/cycle), sorafenib ($25,300/cycle), and outpatient office visits ($181.30/cycle). Model outputs encompassed life-years gained, quality adjusted life-years (QALYs) gained, costs, and incremental cost-effectiveness ratios (ICERs). One-way sensitivity analysis assessed the impact of each parameter’s uncertainty.

RESULTS: Compared to sorafenib, tivozanib yielded 0.83 life-years and 0.08 QALYs gained, with an incremental cost of $402,336 and an ICER of $4,929,385 per QALY. Tivozanib’s cost-effectiveness was most sensitive to its price, followed by pre-pression utility value and sorafenib’s price.

CONCLUSIONS: Tivozanib increased in QALYs at an additional cost compared to sorafenib. At a $150,000/QALY willingness-to-pay threshold, tivozanib was not deemed cost-effective.