Análisis de costo-efectividad del nivolumab + ipilimumab, pembrolizumab + axitinib en comparación con sunitinib para el tratamiento de primera línea del cáncer renal metastásico en Colombia
ilustraciones, diagramas
- Autores:
-
Yepes Hernández, Angie Liceth
- Tipo de recurso:
- Fecha de publicación:
- 2023
- Institución:
- Universidad Nacional de Colombia
- Repositorio:
- Universidad Nacional de Colombia
- Idioma:
- spa
- OAI Identifier:
- oai:repositorio.unal.edu.co:unal/85391
- Palabra clave:
- 610 - Medicina y salud::615 - Farmacología y terapéutica
330 - Economía
Análisis de volumen-costo-beneficio
Contabilidad de costos
Break-even analysis
Cost accounting
Carcinoma de célula renal
Evaluación económica
Análisis de costo efectividad
Nivolumab
Ipilimumab
Pembrolizumab,
Axitinib
Sunitinib
Cost-effectiveness analysis
Renal cell carcinoma
Economic evaluation
Nivolumab
Axitinib
Ipilimumab
Pembrolizumab
Axitinib
Sunitinib
- Rights
- openAccess
- License
- Atribución-NoComercial-SinDerivadas 4.0 Internacional
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UNACIONAL2 |
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Universidad Nacional de Colombia |
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| dc.title.none.fl_str_mv |
Análisis de costo-efectividad del nivolumab + ipilimumab, pembrolizumab + axitinib en comparación con sunitinib para el tratamiento de primera línea del cáncer renal metastásico en Colombia |
| dc.title.translated.eng.fl_str_mv |
A cost-effectiveness analysis of nivolumab + ipilimumab, pembrolizumab + axitinib compared with sunitinib in first-line treatment of metastatic renal cell carcinoma in Colombia |
| title |
Análisis de costo-efectividad del nivolumab + ipilimumab, pembrolizumab + axitinib en comparación con sunitinib para el tratamiento de primera línea del cáncer renal metastásico en Colombia |
| spellingShingle |
Análisis de costo-efectividad del nivolumab + ipilimumab, pembrolizumab + axitinib en comparación con sunitinib para el tratamiento de primera línea del cáncer renal metastásico en Colombia 610 - Medicina y salud::615 - Farmacología y terapéutica 330 - Economía Análisis de volumen-costo-beneficio Contabilidad de costos Break-even analysis Cost accounting Carcinoma de célula renal Evaluación económica Análisis de costo efectividad Nivolumab Ipilimumab Pembrolizumab, Axitinib Sunitinib Cost-effectiveness analysis Renal cell carcinoma Economic evaluation Nivolumab Axitinib Ipilimumab Pembrolizumab Axitinib Sunitinib |
| title_short |
Análisis de costo-efectividad del nivolumab + ipilimumab, pembrolizumab + axitinib en comparación con sunitinib para el tratamiento de primera línea del cáncer renal metastásico en Colombia |
| title_full |
Análisis de costo-efectividad del nivolumab + ipilimumab, pembrolizumab + axitinib en comparación con sunitinib para el tratamiento de primera línea del cáncer renal metastásico en Colombia |
| title_fullStr |
Análisis de costo-efectividad del nivolumab + ipilimumab, pembrolizumab + axitinib en comparación con sunitinib para el tratamiento de primera línea del cáncer renal metastásico en Colombia |
| title_full_unstemmed |
Análisis de costo-efectividad del nivolumab + ipilimumab, pembrolizumab + axitinib en comparación con sunitinib para el tratamiento de primera línea del cáncer renal metastásico en Colombia |
| title_sort |
Análisis de costo-efectividad del nivolumab + ipilimumab, pembrolizumab + axitinib en comparación con sunitinib para el tratamiento de primera línea del cáncer renal metastásico en Colombia |
| dc.creator.fl_str_mv |
Yepes Hernández, Angie Liceth |
| dc.contributor.advisor.none.fl_str_mv |
Díaz Rojas, Jorge Augusto |
| dc.contributor.author.none.fl_str_mv |
Yepes Hernández, Angie Liceth |
| dc.contributor.researchgroup.spa.fl_str_mv |
Evaluación Económica de Tecnologías en Salud |
| dc.subject.ddc.spa.fl_str_mv |
610 - Medicina y salud::615 - Farmacología y terapéutica 330 - Economía |
| topic |
610 - Medicina y salud::615 - Farmacología y terapéutica 330 - Economía Análisis de volumen-costo-beneficio Contabilidad de costos Break-even analysis Cost accounting Carcinoma de célula renal Evaluación económica Análisis de costo efectividad Nivolumab Ipilimumab Pembrolizumab, Axitinib Sunitinib Cost-effectiveness analysis Renal cell carcinoma Economic evaluation Nivolumab Axitinib Ipilimumab Pembrolizumab Axitinib Sunitinib |
| dc.subject.lemb.spa.fl_str_mv |
Análisis de volumen-costo-beneficio Contabilidad de costos |
| dc.subject.lemb.eng.fl_str_mv |
Break-even analysis Cost accounting |
| dc.subject.proposal.spa.fl_str_mv |
Carcinoma de célula renal Evaluación económica Análisis de costo efectividad Nivolumab Ipilimumab Pembrolizumab, Axitinib Sunitinib Cost-effectiveness analysis |
| dc.subject.proposal.eng.fl_str_mv |
Renal cell carcinoma Economic evaluation Nivolumab Axitinib Ipilimumab Pembrolizumab Axitinib Sunitinib |
| description |
ilustraciones, diagramas |
| publishDate |
2023 |
| dc.date.issued.none.fl_str_mv |
2023-11-29 |
| dc.date.accessioned.none.fl_str_mv |
2024-01-22T16:08:08Z |
| dc.date.available.none.fl_str_mv |
2024-01-22T16:08:08Z |
| dc.type.spa.fl_str_mv |
Trabajo de grado - Maestría |
| dc.type.driver.spa.fl_str_mv |
info:eu-repo/semantics/masterThesis |
| dc.type.version.spa.fl_str_mv |
info:eu-repo/semantics/acceptedVersion |
| dc.type.content.spa.fl_str_mv |
Text Other |
| dc.type.redcol.spa.fl_str_mv |
http://purl.org/redcol/resource_type/TM |
| status_str |
acceptedVersion |
| dc.identifier.uri.none.fl_str_mv |
https://repositorio.unal.edu.co/handle/unal/85391 |
| dc.identifier.instname.spa.fl_str_mv |
Universidad Nacional de Colombia |
| dc.identifier.reponame.spa.fl_str_mv |
Repositorio Institucional Universidad Nacional de Colombia |
| dc.identifier.repourl.spa.fl_str_mv |
https://repositorio.unal.edu.co/ |
| url |
https://repositorio.unal.edu.co/handle/unal/85391 https://repositorio.unal.edu.co/ |
| identifier_str_mv |
Universidad Nacional de Colombia Repositorio Institucional Universidad Nacional de Colombia |
| dc.language.iso.spa.fl_str_mv |
spa |
| language |
spa |
| dc.relation.references.spa.fl_str_mv |
Akl, E., Mustafa, R., Santesso, N., & Wiercioch, W. (2013). GRADE handbook. Chapter 5. Quality of evidence. GRADE Handbook. https://gdt.gradepro.org/app/handbook/handbook.html#h.svwngs6pm0f2 Ávila, D., Chocontá Piraquive, L. A., Manneth-Kopp, R. A., Ordóñez, A., Orozco, L. E., Osorio Arango, L. K., Ospina Lizarazo, N., Pieschacón, J. R., Posada, A., Sanmartin, D. J., Segura, D., & Rojas, M. X. (2020). Posicionamiento terapéutico para el tratamiento farmacológico del carcinoma renal avanzado , metastásico con predominio de células claras , que requiera tratamiento sistémico oncológico. Bensimon, A. G., Zhong, Y., Swami, U., Briggs, A., Feng, Y., Song, Y., Signorovitch, J., Adejoro, O., Chakravarty, A., Chen, M., Perini, R. F., Geynisman, D. M., Bensimon, A. G., Zhong, Y., Swami, U., Briggs, A., Young, J., Feng, Y., Song, Y., … Group, F. (2020). Cost-effectiveness of pembrolizumab with axitinib as first-line treatment for advanced renal cell carcinoma. https://doi.org/10.1080/03007995.2020.1799771 Bosma, N. A., Warkentin, M. T., Gan, C. L., Karim, S., Heng, D. Y. C., Brenner, D. R., & Lee-Ying, R. M. (2022). Efficacy and Safety of First-line Systemic Therapy for Metastatic Renal Cell Carcinoma: A Systematic Review and Network Meta-analysis. European Urology Open Science, 37, 14–26. https://doi.org/10.1016/j.euros.2021.12.007 Brahmer, J. R., Lacchetti, C., Schneider, B. J., Atkins, M. B., Brassil, K. J., Caterino, J. M., Chau, I., Ernstoff, M. S., Gardner, J. M., Ginex, P., Hallmeyer, S., Chakrabarty, J. H., Leighl, N. B., Mammen, J. S., McDermott, D. F., Naing, A., Nastoupil, L. J., Phillips, T., Porter, L. D., … Thompson, J. A. (2018). Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: American society of clinical oncology clinical practice guideline. 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Estimaciones del cambio demográfico. 2022. Retrieved July 4, 2023, from https://www.dane.gov.co/index.php/estadisticas-por-tema/demografia-y-poblacion/estimaciones-del-cambio-demografico Deeks, E. D., & Keating, G. M. (2006). Sunitinib. 66(17), 2255–2266. Drummond, M., Sculpher, M., Torrance, G., O’Brien, B., & Stoddart, G. (2005). Methods fo Economic Evaluation of Health Care Programmes. In Oxford University Press Inc (Issue 3). https://eur-lex.europa.eu/legal-content/PT/TXT/PDF/?uri=CELEX:32016R0679&from=PT%0Ahttp://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=CELEX:52012PC0011:pt:NOT Edlin, R., McCabe, C., Hulme, C., Hall, P., & Wright, J. (2015). Cost Effectiveness Modelling for Health Technology Assessment. In Cost Effectiveness Modelling for Health Technology Assessment. https://doi.org/10.1007/978-3-319-15744-3 Escudier, B., Porta, C., Schmidinger, M., Rioux-Leclercq, N., Bex, A., Khoo, V., Grünwald, V., Gillessen, S., & Horwich, A. (2019). Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 30(5), 706–720. https://doi.org/10.1093/annonc/mdz056 Espinosa, O., Rodríguez-Lesmes, P., Orozco, L., Ávila, Di., Enríquez, H., Romano, G., & Ceballos, M. (2022). Estimating cost-effectiveness thresholds under a managed healthcare system: experiences from Colombia. Health Policy and Planning, 37(3), 359–368. https://doi.org/10.1093/HEAPOL/CZAB146 Fiebig, J., & Kraywinkel, K. (2019). Epidemiology of renal cell carcinoma in Germany. Onkologe, 11(3), 79–87. https://doi.org/10.1007/s00761-019-0580-7 Gao, X., & McDermott, D. F. (2018). Ipilimumab in combination with nivolumab for the treatment of renal cell carcinoma. Expert Opinion on Biological Therapy, 18(9), 947. https://doi.org/10.1080/14712598.2018.1513485 Hao, X., Shen, A., & Wu, B. (2021). Cost-Effectiveness of Nivolumab Plus Ipilimumab as First-Line Therapy in Advanced Non–small-cell Lung Cancer. 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A., Heng, D. Y. C., Basappa, N. S., Wood, L., Iqbal, N., McLeod, D., & Kollmannsberger, C. (2022). Evolving landscape of first-line combination therapy in advanced renal cancer: a systematic review. Therapeutic Advances Medical Oncology, 14(6), 1–17. https://doi.org/10.1177/https Latimer, N. (2011). NICE DSU technical support document 14: survival analysis for economic evaluations alongside clinical trials-extrapolation with patient-level data. Sheffield: Report by the Decision Support Unit, 0. http://www.nicedsu.org.uk/NICE DSU TSD Survival analysis.updated March 2013.v2.pdf Li, S. N., Li, J. H., Peng, L. B., Li, Y. M., & Wan, X. M. (2021). Cost-Effectiveness of Frontline Treatment for Advanced Renal Cell Carcinoma in the Era of Immunotherapies. Frontiers in Pharmacology, 12(September), 1–10. https://doi.org/10.3389/fphar.2021.718014 Ljungberg, B., Albiges, L., Abu-Ghanem, Y., Bedke, J., Capitanio, U., Dabestani, S., Fernández-Pello, S., Giles, R. H., Hofmann, F., Hora, M., Klatte, T., Kuusk, T., Lam, T. B., Marconi, L., Powles, T., Tahbaz, R., Volpe, A., Bex, A., & Catto, J. (2022). European Association of Urology Guidelines on Renal Cell Carcinoma: The 2022 Update. Eur Urol. https://doi.org/10.1016/j.eururo.2022.03.006 Lombardi, P., Filetti, M., Falcone, R., Di Bidino, R., Iacovelli, R., Ciccarese, C., Bria, E., Tortora, G., Scambia, G., & Daniele, G. (2022). New first-line immunotherapy-based combinations for metastatic renal cell carcinoma: A systematic review and network meta-analysis. Cancer Treatment Reviews, 106(November 2021), 102377. https://doi.org/10.1016/j.ctrv.2022.102377 Makhov, P., Joshi, S., Ghatalia, P., Kutikov, A., Uzzo, R. G., & Kolenko, V. M. (2018). Resistance to Systemic Therapies in Clear Cell Renal Cell Carcinoma: Mechanisms and Management Strategies. Molecular Cancer Therapeutics, 17(7), 1355–1364. https://doi.org/10.1158/1535-7163.MCT-17-1299 Massari, F., Rizzo, A., Mollica, V., Rosellini, M., Marchetti, A., Ardizzoni, A., & Santoni, M. (2021). Immune-based combinations for the treatment of metastatic renal cell carcinoma: a meta-analysis of randomised clinical trials. European Journal of Cancer, 154, 120–127. https://doi.org/10.1016/j.ejca.2021.06.015 Ministerio de Salud Argentina. (2021). Umbrales de costo-efectividad para evaluacíon de tecnologías sanitarias. 14. https://www.argentina.gob.ar/sites/default/files/umbral-de-costo-efectividad-para-la-evaluacion-de-tecnologias-sanitarias.pdf Ministerio de Salud y Protección Social. (2011). Ley 1438 de 2011. Ley 1438 de 2011. https://doi.org/10.2307/j.ctvswx8sw.11 Monteiro, F. S. M., Soares, A., Debiasi, M., Schutz, F. A., Maluf, F. C., Bastos, D. A., Sasse, A., Cauduro, C. G. S., Mendes, G. O., Ziegelmann, P. K., & Fay, A. P. (2020). First-line Treatment of Metastatic Renal Cell Carcinoma in the Immuno-oncology Era: Systematic Review and Network Meta-analysis. Clinical Genitourinary Cancer, 18(4), 244-251.e4. https://doi.org/10.1016/j.clgc.2020.02.012 Motzer, Rini, et al. (2020). Nivolumab plus ipilimumab versus sunitinib in first-line treatment for advanced renal cell carcinoma: extended follow-up of efficacy and safety results from a randomised phase 3 trial. Lancet Oncol. 2019 October ; 20(10): 1370–1385. Doi:10.1016/S1470-2045(19)30413-9. Corresponding, 176(5), 139–148. https://doi.org/10.1016/S1470-2045(19)30413-9.Corresponding Motzer, R. J., Jonasch, E., Agarwal, N., Alva, A., Baine, M., Beckermann, K., Carlo, M. I., Choueiri, T. K., Costello, B. A., Derweesh, I. H., Desai, A., Ged, Y., George, S., Gore, J. L., Haas, N., Hancock, S. L., Kapur, P., Kyriakopoulos, C., Lam, E. T., … Motter, A. (2022). Kidney Cancer, Version 3.2022, NCCN Clinical Practice Guidelines in Oncology. JNCCN Journal of the National Comprehensive Cancer Network, 20(1), 71–90. https://doi.org/10.6004/jnccn.2022.0001 Motzer, R. J., McDermott, D. F., Escudier, B., Burotto, M., Choueiri, T. K., Hammers, H. J., Barthélémy, P., Plimack, E. R., Porta, C., George, S., Powles, T., Donskov, F., Gurney, H., Kollmannsberger, C. K., Grimm, M. O., Barrios, C., Tomita, Y., Castellano, D., Grünwald, V., … Tannir, N. M. (2022). Conditional survival and long-term efficacy with nivolumab plus ipilimumab versus sunitinib in patients with advanced renal cell carcinoma. Cancer, 128(11), 2085–2097. https://doi.org/10.1002/cncr.34180 Nocera, L., Karakiewicz, P. I., Wenzel, M., Tian, Z., Shariat, S. F., Saad, F., Chun, F. K. H., Briganti, A., Kapoor, A., & Lalani, A. K. (2022). Clinical Outcomes and Adverse Events after First-Line Treatment in Metastatic Renal Cell Carcinoma: A Systematic Review and Network Meta-Analysis. Journal of Urology, 207(1), 16–24. https://doi.org/10.1097/JU.0000000000002252 Panamerican Health Organization. (2022). PAHO/WHO | Health Technology Assessment (HTA). Retrieved June 26, 2022, from https://www3.paho.org/hq/index.php?option=com_content&view=article&id=9229:2013-tecnologias-sanitarias&Itemid=41687&lang=en Powles, T., Plimack, E. R., Soulières, D., Waddell, T., Stus, V., Gafanov, R., Nosov, D., Pouliot, F., Melichar, B., Vynnychenko, I., Azevedo, S. J., Borchiellini, D., McDermott, R. S., Bedke, J., Tamada, S., Yin, L., Chen, M., Molife, L. R., Atkins, M. B., & Rini, B. I. (2020). Pembrolizumab plus axitinib versus sunitinib monotherapy as first-line treatment of advanced renal cell carcinoma (KEYNOTE-426): extended follow-up from a randomised, open-label, phase 3 trial. The Lancet Oncology, 21(12), 1563–1573. https://doi.org/10.1016/S1470-2045(20)30436-8 Prieto Martínez, V. A. (2016). Evaluación económica de los tratamientos de primera línea en pacientes con carcinoma de células renales metastásico en Colombia. Quhal, F., Mori, K., Bruchbacher, A., Resch, I., Mostafaei, H., Pradere, B., Schuettfort, V. M., Laukhtina, E., Egawa, S., Fajkovic, H., Remzi, M., Shariat, S. F., & Schmidinger, M. (2021). First-line Immunotherapy-based Combinations for Metastatic Renal Cell Carcinoma: A Systematic Review and Network Meta-analysis. European Urology Oncology, 4(5), 755–765. https://doi.org/10.1016/j.euo.2021.03.001 Quiroga Matamoros, W., Fernandez, F., Citarella Otero, D., Rangel, J., Estrada Guerrero, A., & Patiño, I. D. (2016). Guía de manejo del carcinoma de células renales. Urología Colombiana, 25(2), 169–189. https://doi.org/10.1016/j.uroco.2016.03.002 Rini, B. I. (1996). Sunitinib. Exper Opinion on Pharmacotherapy, 8(14), 2359–2369. https://doi.org/10.1136/bmj.3.5611.176-a Rini, B. I., Plimack, E. 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Clinics in Plastic Surgery, 40(2), 281. https://doi.org/10.1016/J.CPS.2012.10.004 Shay, R., Nicklawsky, A., Gao, D., & Lam, E. T. (2021). A Cost-Effectiveness Analysis of Nivolumab Plus Ipilimumab Versus Pembrolizumab Plus Axitinib and Versus Avelumab Plus Axitinib in First-Line Treatment of Advanced Renal Cell Carcinoma. Clinical Genitourinary Cancer, 19(4), 370-370.e7. https://doi.org/10.1016/j.clgc.2021.01.009 Shpilsky, J., Catalano, P. J., & McDermott, D. F. (2021). First-Line Immunotherapy Combinations in Advanced Renal Cell Carcinoma: A Rapid Review and Meta-Analysis. Kidney Cancer, 5(3), 153–163. https://doi.org/10.3233/KCA-210120 Soto Álvarez, J. (2012). Diseño Y Realización De Evaluaciones Económicas a Través De Modelos Analíticos De Decisión. In Evaluación económica de medicamentos y tecnologías sanitarias: https://doi.org/10.1007/978-84-940346-6-4_12 Su, Y., Fu, J., Du, J., & Wu, B. (2020). First-line treatments for advanced renal- cell carcinoma with immune checkpoint inhibitors : systematic review , network meta- analysis and cost-effectiveness analysis. 1–11. https://doi.org/10.1177/https Tartari, F., Santoni, M., Burattini, L., Mazzanti, P., Onofri, A., & Berardi, R. (2016). Economic sustainability of anti-PD-1 agents nivolumab and pembrolizumab in cancer patients: Recent insights and future challenges. Cancer Treatment Reviews, 48, 20–24. https://doi.org/10.1016/j.ctrv.2016.06.002 Vogelzang, N. J., & Stadler, W. M. (1998). Kidney cancer. The Lancet, 352(9141), 1691–1696. https://doi.org/10.1016/S0140-6736(98)01041-1 Wan, X., Peng, L., & Li, Y. (2015). A review and comparison of methods for recreating individual patient data from published Kaplan-Meier survival curves for economic evaluations: A simulation study. PLoS ONE, 10(3), 1–21. https://doi.org/10.1371/journal.pone.0121353 Watson, T. R., Gao, X., Reynolds, K. L., & Kong, C. Y. (2020a). cost-Effectiveness of pembrolizumab plus axitinib vs nivolumab plus ipilimumab as fisrt-line treatment of advanced renal cell carcinoma in the US. JAMA Network. |
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Atribución-NoComercial-SinDerivadas 4.0 Internacionalhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Díaz Rojas, Jorge Augustoec3d060d221609e5088d2b55505c5f5cYepes Hernández, Angie Liceth29e064e9b8608f0d0f708c39502e15feEvaluación Económica de Tecnologías en Salud2024-01-22T16:08:08Z2024-01-22T16:08:08Z2023-11-29https://repositorio.unal.edu.co/handle/unal/85391Universidad Nacional de ColombiaRepositorio Institucional Universidad Nacional de Colombiahttps://repositorio.unal.edu.co/ilustraciones, diagramasObjetivo: Estimar la costo - efectividad del nivolumab + ipilimumab, pembrolizumab + axitinib en comparación con sunitinib como tratamientos de primera línea de pacientes con cáncer renal metastásico en Colombia Métodos: Se construyó un modelo de supervivencia particionado de tres estados (supervivencia libre de progresión, supervivencia en progresión y muerte) para estimar los años de vida ganados (AVG) y los años de vida ganados ajustados por calidad (AVAC) de tres alternativas terapéuticas para el tratamiento en primera línea de pacientes con cáncer renal metastásico (CRM) de célula clara con riesgo intermedio/desfavorable: nivolumab + ipilimumab, pembrolizumab + axitinib comparado con sunitinib. Los datos de eficacia y seguridad se basaron en los resultados de los estudios CheckMate 214 y KEYNOTE-426. La evaluación económica se realizó desde la perspectiva del tercer pagador en Colombia y un horizonte temporal de 5 años. Los costos de tratamiento fueron estimados a partir de bases de datos y manuales tarifarios de Colombia. La estimación de los costos se realizó bajo dos escenarios diferenciados por la segunda línea de tratamiento. Se utilizó una tasa de descuento de 5% a los costos y beneficios. Los resultados fueron evaluados con el análisis de sensibilidad determinístico y probabilístico. Resultados: En el primer escenario, los costos de tratamiento fueron $ 354.241.680 (sunitinib), $713.422.858 (pembrolizumab + axitinib) y $ 719.715.015 (nivolumab + ipilimumab). En el segundo escenario, los costos de tratamiento fueron $ 354.241.680 (sunitinib), $1.138.175.758 (pembrolizumab + axitinib) y $1.086.695.432 (nivolumab + ipilimumab). Se estimó una ganancia de 0,42 años de vida y 0,26 AVAC para nivolumab + ipilimumab comparado con sunitinib, 0,37 años de vida y 0,18 AVAC para pembrolizumab + axitinib comparado con sunitinib. El pembrolizumab + axitinib fue dominado por el nivolumab + ipilimumab en los dos escenarios. La razón de costo-efectividad incremental (RCEI) del nivolumab + ipilimumab comparado con sunitinib fue de $ 1.098.260.790/AVAC (escenario 1) y $ 2.201.050.419/AVAC (escenario 2), valores que estuvieron por encima del nivel de disposición a pagar en Colombia ($23.313.600/AVAC). El análisis de sensibilidad probabilístico demostró la robustez de los resultados, las terapias combinadas tuvieron mejores resultados y mayores costos en el 92,0% de las simulaciones. Conclusión El presente análisis indica que el nivolumab + ipilimumab y el pembrolizumab + axitinib no son terapias costo-efectivas en el tratamiento de pacientes con CRM de célula clara con riesgo intermedio/desfavorable en Colombia. (Texto tomado de la fuente)Objectives: To estimate the cost-effectiveness of nivolumab + ipilimumab, pembrolizumab + axitinib compared to sunitinib as first-line treatments for patients with metastatic renal cancer in Colombia Methods: A three-state partitioned survival model (progression-free survival, progression survival, and death) was constructed to estimate the life years gained (LY) and the quality-adjusted life years (QALYs) of three therapeutic alternatives for first-line treatment of patients with intermediate/poor-risk metastatic renal cancer (mRC): nivolumab + ipilimumab, pembrolizumab + axitinib compared with sunitinib. Efficacy and safety data were based on the results of the CheckMate 214 and KEYNOTE-426 clinical trials. The economic evaluation was carried out from the perspective of the third payer in Colombia and a time horizon of 5 years. Treatment costs were estimated from Colombian databases and tariff manuals. Cost estimation was performed under two scenarios differentiated by the second line of treatment. A 5% discount rate was applied to costs and benefits. The results were evaluated with deterministic and probabilistic sensitivity analysis. Results: Costs were estimated under two differentiated scenarios regarding to second line. In the first scenario, the treatment costs were $354.241.680 (sunitinib), $713.422.858 (pembrolizumab + axitinib) and $719,715,015 (nivolumab + ipilimumab). In the second scenario, the treatment costs were $354.241.680 (sunitinib), $1.138.175.758 (pembrolizumab + axitinib) and $1.086.695.432 (nivolumab + ipilimumab). It was estimated 0,42 LY and 0,26 QALYs for nivolumab + ipilimumab compared with sunitinib, 0,37 LY and 0,18 QALYs for pembrolizumab + axitinib compared with sunitinib. Pembrolizumab + axitinib was dominated by nivolumab + ipilimumab in both scenarios. The incremental cost-effectiveness ratio (ICER) of nivolumab + ipilimumab compared to sunitinib was $1.098.260.790/QALY (scenario 1) and $2.201.050.419 (scenario 2), these values were above the willingness to pay threshold in Colombia ($23.313.600 /QALY). The probabilistic sensitivity analysis demonstrated the robustness of the results, the combined therapies had better results and higher costs in 92,0% of the simulations. Conclusion: The present analysis indicates that nivolumab + ipilimumab and pembrolizumab + axitinib are not cost-effective therapies in the treatment of patients with intermediate/poor risk clear cell mRC in Colombia.MaestríaMagister en Ciencias - farmacologíaFarmacoeconomíaxiv, 88 páginasapplication/pdfspaUniversidad Nacional de ColombiaBogotá - Ciencias - Maestría en Ciencias - FarmacologíaFacultad de CienciasBogotá,ColombiaUniversidad Nacional de Colombia - Sede Bogotá610 - Medicina y salud::615 - Farmacología y terapéutica330 - EconomíaAnálisis de volumen-costo-beneficioContabilidad de costosBreak-even analysisCost accountingCarcinoma de célula renalEvaluación económicaAnálisis de costo efectividadNivolumabIpilimumabPembrolizumab,AxitinibSunitinibCost-effectiveness analysisRenal cell carcinomaEconomic evaluationNivolumabAxitinibIpilimumabPembrolizumabAxitinibSunitinibAnálisis de costo-efectividad del nivolumab + ipilimumab, pembrolizumab + axitinib en comparación con sunitinib para el tratamiento de primera línea del cáncer renal metastásico en ColombiaA cost-effectiveness analysis of nivolumab + ipilimumab, pembrolizumab + axitinib compared with sunitinib in first-line treatment of metastatic renal cell carcinoma in ColombiaTrabajo de grado - Maestríainfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/acceptedVersionTextOtherhttp://purl.org/redcol/resource_type/TMColombiaAkl, E., Mustafa, R., Santesso, N., & Wiercioch, W. 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JAMA Network.EstudiantesInvestigadoresPúblico generalLICENSElicense.txtlicense.txttext/plain; charset=utf-85879https://repositorio.unal.edu.co/bitstream/unal/85391/1/license.txteb34b1cf90b7e1103fc9dfd26be24b4aMD51ORIGINAL1022419808.2023.pdf1022419808.2023.pdfTesis de Maestría en Ciencias - Farmacologíaapplication/pdf2396114https://repositorio.unal.edu.co/bitstream/unal/85391/2/1022419808.2023.pdfad59df410c823a689c4a8a2eeadfe20bMD52THUMBNAIL1022419808.2023.pdf.jpg1022419808.2023.pdf.jpgGenerated Thumbnailimage/jpeg5949https://repositorio.unal.edu.co/bitstream/unal/85391/3/1022419808.2023.pdf.jpg7e685972ff8971fb1317e30418e85063MD53unal/85391oai:repositorio.unal.edu.co:unal/853912024-01-22 23:03:36.618Repositorio Institucional Universidad Nacional de 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