Details regarding cost-effectiveness studies of genitourinary cancers

Reference, Country, YearComparisonMethodologyaCostsQALYsICERWTPConclusionsCriticisms
Wan et al., USA, 2017 [33]Nivo vs evero for recurrent RCCPS; accounted for toxicity and administration costs$211,407 nivo, $167,405 evero1.79 nivo, 1.5 everoRelative to evero, nivo $151,676/QALY$100,000/QALYNivo 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 RCCPS; accounted for toxicity, administration, follow-up, and end-of-life costs$197,089 nivo, $163,902 evero2.79 nivo, 2.15 everoRelative to evero, nivo $51,714/QALY$150,000/QALYNivo 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 RCCMarkov; accounted for toxicity and administration costs$101,070 nivo, $50,935 everoNivo 0.34 QALYs higher than evero/placeboRelative to evero, nivo $146,532/QALY; relative to placebo, nivo $226,197/QALY$100–150,000/QALYNivo 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 cancerMarkov; accounted for toxicity and administration costsCost of pembro $44,325 higher than taxanesPembro 0.36 QALYs higher than taxanesRelative to taxanes, pembro $122,557/QALY$100–150,000/QALYCost-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

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

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