Análisis de costo-efectividad de cabozantinib frente a nivolumab, axitinib, everolimus y sorafenib para el tratamiento en segunda línea de pacientes adultos con carcinoma de células renales en Colombia

Abstract

Introduction: Renal cell carcinoma (RCC) is the second most common urogenital neoplasm. After patients have received a first line of treatment, there are therapeutic alternatives in monotherapy such as immunotherapy, tyrosine kinase inhibitors (TKI) or inhibitors of the mTOR pathway. Cabozantinib is a new TKI treatment entering to Colombian that has proven its efficacy in clinical trials. Objective: Calculate the incremental cost-effectiveness ratio (ICER) of cabozantinib versus the second-line treatment of adult patients diagnosed with advanced RCC in Colombia. Methods: A partitioned model of health states with three states was developed to evaluate the cost-effectiveness of cabozantinib and its relevant comparators in this clinical context. The time horizon was defined was 3 years. Each Quality-Adjusted Life Years (QALYs) gained by each of the therapies was taken as the unit of effectiveness. Costs were extracted from Colombian public sources (SISMED, ISS Tariff Manual, Colombian Clinical Practice Guidelines of the National Cancer Institute). Results: Cabozantinib showed to have the longest progression free survival, while the overall survival of cabozantinib was only surpassed by nivolumab. Probabilistic sensitivity analysis was performed using 10,000 simulations for each comparator, where the results were stable for changes in the value of the variables. Conclusions: Cabozantinib can be considered as dominant treatment over nivolumab, and is more effective than the other alternatives, but at a higher cost.