Supplementary MaterialsAdditional file 1: Calibration curve: progression-free and overall survival. 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 0.70C0.76 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 Rabbit Polyclonal to NOX1 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, U0126-EtOH ic50 which is available to authorized users. statistic, the Weibull survival function and Log-logistic survival function were employed for fitted the KaplanCMeier PFS and OS probabilities of the sunitinib and nivolumab plus ipilimumab strategy, respectively. The estimated parameters of the Weibull survival function and Log-logistic model are shown in Table?1, and calibration curve showed in Additional file?1. The duration of the PFS and PD phases in two competing strategies was calculated using the area under the PFS and OS survival curves. The difference between the OS and PFS estimated in the parametric success models was employed for determining the possibility from PD to loss of life. [18] Following the disease advanced, about 66, 15.8 and 33% of sufferers in america, UK and China would receive second-line dynamic treatment according to previous reports [19C21]. Table 1 Important clinical and health preference data thead th rowspan=”1″ colspan=”1″ Guidelines /th th rowspan=”1″ colspan=”1″ Ideals /th th rowspan=”1″ colspan=”1″ Research /th /thead Log-logistic survival model of PFS of sunitinibScale?=?0.01302; Shape?=?1.174; r2?=?0.9997[12]Log-logistic survival magic size of PFS of nivolumab plus ipilimumabScale?=?0.02487; Shape?=?0.9312; r2?=?0.9995[12]Weibull survival model of OS of sunitinib armScale?=?0.00685; Shape?=?0.9778; r2?=?0.9939[12]Weibull survival magic size of OS of nivolumab plus ipilimumabScale?=?0.00414; Shape?=?0.9938; r2?=?0.9993[12]Probability (%) of total AEs (grade 1 and 2)?Sunitinib34 (Range:26C43)[12]?Nivolumab in addition Ipilimumab47 (Range:59C12)[12]Probability (%) of total AEs (grade??3)?Sunitinib63 (Range:47C79)[12]?Nivolumab in addition Ipilimumab46 (Range:35C58)[12]Probability (%) of fatigue (grade??3)?Sunitinib9.2 (Range:6.9C11.4)[12]?Nivolumab plus Ipilimumab4.2 (Range:3.2C5.3)[12]Probability (%) of hypertension (grade??3)?Sunitinib15.9 (Range:11.9C19.9)[12]?Nivolumab plus Ipilimumab0.7 (Range:0.5C0.9)[12]Probability (%) of anemia (grade??3)?Sunitinib4.5 (Range:3.4C5.6)[12]?Nivolumab in addition Ipilimumab0.4 (Range:0.3C0.5)[12]Probability (%) of palmarCplantar erythrodysesthesia (grade??3)?Sunitinib9.2 (Range:6.9C11.4)[12]?Nivolumab in addition Ipilimumab0 (Range:0C0)[12]Probability (%) of thrombocytopenia (grade??3)?Sunitinib4.7 (Range:3.5C5.8)[12]?Nivolumab in addition Ipilimumab0 (Range:0C0)[12]Proportion (%) of receiving active second-line treatment[19C21]?US66 (Range:7.5C80)?UK15.8 (Range:7.5C80)?China33 (Range:7.5C80)Health preferences?Power of PFS0.78 (Range:0.71C0.849)[24, 29, 41, 42]?Power of PD0.66 (Range:0.45C0.823)[24, 29, 41, 42]?Disutility due to AEs (grade 1 and 2)0.014 (Range:0.008C0.02)[41]?Disutility due to AEs (grade??3)0.157 (Range:0.11C0.204)[41] Open in a separate window em Abbreviations /em : em AE /em , adverse event; em PD /em , progressed disease; em PFS /em , progression-free survival; em OS /em , U0126-EtOH ic50 U0126-EtOH ic50 overall survival Cost and power estimations This analysis used the third-party payer, the National Health Services and health care perspectives in the US, UK and China, respectively, which only considered direct medical costs, including the 1st- and second-line treatment, management of treatment-related severe adverse events (SAEs), routine follow-ups and monitoring, best supportive care (BSC) and terminal care (Table?2). For comparability, costs for three countries were reported in 2017 US dollars. GBP and Chinese Yuan were converted into US dollars by using the pursuing exchange formulation: 1US $?=?GBP 0.7075 and 1US $?=?CNY 6.8. US and UK costs connected with health care providers had been inflated to 2017 beliefs based on the US and UK customer cost index. [22, 23] As prior study performed, we therefore followed the strategy of taking the common upsurge in the index for the prior 3 years when regional index is absence [23]. As the Chinese language healthcare costs had been managed with the nationwide federal government and held steady, the Chinese language costs weren’t.