Frontiers in immunology · 2026
First-line immune checkpoint inhibitors combined with targeted therapy for advanced renal cell carcinoma: a network meta-analysis and cost-effectiveness analysis.
СтатьяNetwork Meta-AnalysisСистематический обзорНазвание и аннотация: Перевод пока не подготовлен
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Jia Yize, Zhao Shan, Wang Xiaohui, Kang Shuo
Аннотация
OBJECTIVE: This study aimed to systematically evaluate the efficacy of first-line immune checkpoint inhibitors (ICIs) combined with targeted therapy for advanced renal cell carcinoma (RCC) and assess their cost-effectiveness from the perspective of the Chinese healthcare system.
METHODS: Phase III randomized controlled trials comparing ICI-targeted combinations versus sunitinib as first-line treatment for advanced RCC were identified through systematic searches of PubMed, EMBASE, and the Cochrane Library. A network meta-analysis (NMA) was performed to compare the hazard ratios (HRs) for progression-free survival (PFS) and overall survival (OS) among different regimens. The surface under the cumulative ranking curve (SUCRA) was calculated to rank treatment efficacy. Based on the NMA results, a partitioned survival model was developed for the cost-effectiveness analysis. Using the sunitinib arm from the CheckMate 9ER trial as the reference, parametric survival models were fitted to extrapolate survival outcomes over a 20-year time horizon. HRs from the NMA were applied to derive survival curves for other interventions. The model cycle length was 6 weeks. Costs included drug acquisition, follow-up, adverse event management, subsequent therapy, and palliative care. Utility values were sourced from published literature. An incremental cost-effectiveness ratio (ICER) was calculated against a willingness-to-pay (WTP) threshold of $40,332.35 per quality-adjusted life-year (QALY). Sensitivity and scenario analyses were conducted.
RESULTS: Seven trials involving 4,973 patients were included. The NMA showed that pembrolizumab plus lenvatinib ranked highest for PFS, whereas toripalimab plus axitinib ranked highest for OS. The cost-effectiveness analysis indicated that toripalimab plus axitinib yielded the greatest gains in life-years and QALYs, with the lowest ICER of $62,204.37 among all evaluated strategies. However, all regimens exceeded the WTP threshold of $40,332.35 per QALY. Sensitivity analyses confirmed the robustness of these findings.
CONCLUSION: This study demonstrates that while toripalimab plus axitinib is the most efficacious first-line regimen for aRCC and offers the lowest ICER, none of the evaluated regimens are economically viable from the perspective of the Chinese healthcare system at the WTP threshold of $40,332.35 per QALY.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261503119, identifier CRD420261503119.
METHODS: Phase III randomized controlled trials comparing ICI-targeted combinations versus sunitinib as first-line treatment for advanced RCC were identified through systematic searches of PubMed, EMBASE, and the Cochrane Library. A network meta-analysis (NMA) was performed to compare the hazard ratios (HRs) for progression-free survival (PFS) and overall survival (OS) among different regimens. The surface under the cumulative ranking curve (SUCRA) was calculated to rank treatment efficacy. Based on the NMA results, a partitioned survival model was developed for the cost-effectiveness analysis. Using the sunitinib arm from the CheckMate 9ER trial as the reference, parametric survival models were fitted to extrapolate survival outcomes over a 20-year time horizon. HRs from the NMA were applied to derive survival curves for other interventions. The model cycle length was 6 weeks. Costs included drug acquisition, follow-up, adverse event management, subsequent therapy, and palliative care. Utility values were sourced from published literature. An incremental cost-effectiveness ratio (ICER) was calculated against a willingness-to-pay (WTP) threshold of $40,332.35 per quality-adjusted life-year (QALY). Sensitivity and scenario analyses were conducted.
RESULTS: Seven trials involving 4,973 patients were included. The NMA showed that pembrolizumab plus lenvatinib ranked highest for PFS, whereas toripalimab plus axitinib ranked highest for OS. The cost-effectiveness analysis indicated that toripalimab plus axitinib yielded the greatest gains in life-years and QALYs, with the lowest ICER of $62,204.37 among all evaluated strategies. However, all regimens exceeded the WTP threshold of $40,332.35 per QALY. Sensitivity analyses confirmed the robustness of these findings.
CONCLUSION: This study demonstrates that while toripalimab plus axitinib is the most efficacious first-line regimen for aRCC and offers the lowest ICER, none of the evaluated regimens are economically viable from the perspective of the Chinese healthcare system at the WTP threshold of $40,332.35 per QALY.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261503119, identifier CRD420261503119.