title: Economic evaluation of nivolumab as a second-line treatment for advanced renal cell carcinoma from US and Chinese perspectives.
abstract: BACKGROUND
  Nivolumab is a new standard of care for patients with metastatic renal cell carcinoma (mRCC) and provides an overall survival benefit of 5.40 months in comparison with everolimus. This study evaluated the cost-effectiveness of nivolumab for the second-line treatment of mRCC from the perspective of US payers and identified the range of drug costs for which the addition of nivolumab to standard therapy could be considered cost-effective from a Chinese perspective.
  
  
  METHODS
  A partitioned survival model was constructed to estimate lifetime costs, life-years, and quality-adjusted life-years (QALYs). Costs were estimated for the US and Chinese health care systems. One-way and probabilistic sensitivity analyses were performed.
  
  
  RESULTS
  Nivolumab provided an additional 0.29 QALYs at a cost of $151,676/QALY in the United States. The probabilistic sensitivity analysis showed that at a willingness-to-pay threshold of $100,000/QALY, at the current cost of nivolumab, the chance of nivolumab being cost-effective was 3.10%. For China, when nivolumab cost less than $7.90 or $9.70/mg, there was a nearly 90% likelihood that the incremental cost-effectiveness ratio for nivolumab would be less than $22,785 or $48,838/QALY, respectively.
  
  
  CONCLUSIONS
  For the United States, nivolumab is unlikely to be a high-value treatment for mRCC at the current price, and a price reduction appears to be justified. In China, value-based prices for nivolumab are $7.90 and $9.70/mg for the country and Beijing City, respectively. This study could and should inform the multilateral drug-price negotiations in China that may be upcoming for nivolumab. Cancer 2017;123:2634-41. © 2017 American Cancer Society.
authors.affiliation: Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China.|Department of Pharmacology, School of Pharmaceutical Sciences, Central South University, Changsha, Hunan 410078, China.
authors.forename: Xiao Min
authors.initials: XM
authors.lastname: Wan
authors.affiliation: Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China.
authors.forename: Liu Bao
authors.initials: LB
authors.lastname: Peng
authors.affiliation: Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China.
authors.forename: Jin An
authors.initials: JA
authors.lastname: Ma
authors.affiliation: Department of Pharmacology, School of Pharmaceutical Sciences, Central South University, Changsha, Hunan 410078, China.
authors.forename: Yuan Jian
authors.initials: YJ
authors.lastname: Li
mesh_terms: D000911:Antibodies, Monoclonal / Q000191:economics / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000473:pathology; D002681:China; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D018572:Disease-Free Survival; D016527:Drug Costs; D000068338:Everolimus / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000473:pathology; D018803:Models, Economic; D000077594:Nivolumab; D019057:Quality-Adjusted Life Years; D014481:United States
chemical_list: D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D000077594:Nivolumab; D000068338:Everolimus
keywords: China; United States; advanced renal cell carcinoma; cost-effectiveness; nivolumab