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      Cost-effectiveness of nivolumab plus ipilimumab as first-line therapy in advanced renal-cell carcinoma

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          Abstract

          Background

          Nivolumab plus ipilimumab improves overall survival and is associated with less toxicity compared with sunitinib in the first-line setting of advanced renal-cell carcinoma (RCC). The current study aimed to assess the cost-effectiveness of nivolumab plus ipilimumab for first-line treatment of advanced RCC from the payer perspectives high- and middle-income regions.

          Methods

          A decision-analytic model was constructed to evaluate the health and economic outcomes of first-line sunitinib and nivolumab plus ipilimumab treatment associated with advanced RCC. The clinical and utility data were obtained from published reports. The cost data were acquired for the payer perspectives of the United States (US), United Kingdom (UK), and China. Sensitivity analyses were performed to test the uncertainties of the results. Quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were used.

          Results

          Nivolumab plus ipilimumab gained 0.70–0.76 QALYs compared with sunitinib. Our analysis determined the following ICERs for nivolumab plus ipilimumab over sunitinib in first-line advanced RCC treatment: US $ 85,506 /QALY; UK $ 126,499/QALY; and China $ 4682/QALY. Sensitivity analyses found the model outputs to be most affected for body weight and for the prices of nivolumab, sunitinib and ipilimumab.

          Conclusions

          Nivolumab plus ipilimumab as first-line treatment could gain more health benefits for advanced RCC in comparison with standard sunitinib, which is considered to be cost-effective in the US and China but not in the UK.

          Electronic supplementary material

          The online version of this article (10.1186/s40425-018-0440-9) contains supplementary material, which is available to authorized users.

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          Most cited references36

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          Model parameter estimation and uncertainty analysis: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force Working Group-6.

          A model's purpose is to inform medical decisions and health care resource allocation. Modelers employ quantitative methods to structure the clinical, epidemiological, and economic evidence base and gain qualitative insight to assist decision makers in making better decisions. From a policy perspective, the value of a model-based analysis lies not simply in its ability to generate a precise point estimate for a specific outcome but also in the systematic examination and responsible reporting of uncertainty surrounding this outcome and the ultimate decision being addressed. Different concepts relating to uncertainty in decision modeling are explored. Stochastic (first-order) uncertainty is distinguished from both parameter (second-order) uncertainty and from heterogeneity, with structural uncertainty relating to the model itself forming another level of uncertainty to consider. The article argues that the estimation of point estimates and uncertainty in parameters is part of a single process and explores the link between parameter uncertainty through to decision uncertainty and the relationship to value-of-information analysis. The article also makes extensive recommendations around the reporting of uncertainty, both in terms of deterministic sensitivity analysis techniques and probabilistic methods. Expected value of perfect information is argued to be the most appropriate presentational technique, alongside cost-effectiveness acceptability curves, for representing decision uncertainty from probabilistic analysis.
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            Landmarks in the diagnosis and treatment of renal cell carcinoma.

            The most common renal cancer is renal cell carcinoma (RCC), which arises from the renal parenchyma. The global incidence of RCC has increased over the past two decades by 2% per year. RCC is the most lethal of the common urological cancers: despite diagnostic advances, 20-30% of patients present with metastatic disease. A clearer understanding of the genetic basis of RCC has led to immune-based and targeted treatments for this chemoresistant cancer. Despite promising results in advanced disease, overall response rates and durable complete responses are rare. Surgery remains the main treatment modality, especially for organ-confined disease, with a selective role in advanced and metastatic disease. Smaller tumours are increasingly managed with biopsy, minimally invasive interventions and surveillance. The future promises multimodal, integrated and personalized care, with further understanding of the disease leading to new treatment options.
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              A Systematic Review and Meta-analysis Comparing the Effectiveness and Adverse Effects of Different Systemic Treatments for Non-clear Cell Renal Cell Carcinoma.

              While vascular endothelial growth factor-targeted therapy and mammalian target of rapamycin inhibition are effective strategies in treating clear cell renal cell carcinoma (ccRCC), the most effective therapeutic approach for patients with non-clear cell RCC (non-ccRCC) is unknown.
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                Author and article information

                Contributors
                +86-21-68383427 , scilwsjtu-sunjie@yahoo.com
                Journal
                J Immunother Cancer
                J Immunother Cancer
                Journal for Immunotherapy of Cancer
                BioMed Central (London )
                2051-1426
                20 November 2018
                20 November 2018
                2018
                : 6
                : 124
                Affiliations
                [1 ]ISNI 0000 0004 0368 8293, GRID grid.16821.3c, Medical Decision and Economic Group, Department of Pharmacy, , South Campus, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, ; Shanghai, China
                [2 ]ISNI 0000 0001 2372 7462, GRID grid.412540.6, Department of Clinical Oncology, Putuo Hospital, , Shanghai University of Traditional Chinese Medicine, ; Shanghai, China
                [3 ]ISNI 0000 0004 0368 8293, GRID grid.16821.3c, Department of Urology, Ren Ji Hospital, School of Medicine, , Shanghai Jiaotong University, ; Shanghai, China
                Article
                440
                10.1186/s40425-018-0440-9
                6247499
                30458884
                a8a941c0-3490-459a-9946-69e4543eefe2
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 10 July 2018
                : 31 October 2018
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100010032, Foundation of Shanghai Municipal Commission of Health and Family Planning;
                Award ID: 15GWZK0901
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                renal cell carcinoma,nivolumab,ipilimumab,sunitinib,cost-effectiveness

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