{
  "abstract": "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.\n\nMethods: 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.\n\nResults: 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.\n\nConclusion: 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.\n\nSystematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261503119 , identifier CRD420261503119.",
  "abstract_shown": true,
  "affiliations": [
    "School of Pharmacy, Hebei Medical University , ,",
    "Department of Oncology, The Second Hospital of Hebei Medical University , ,",
    "Medical Insurance Office, The Second Hospital of Hebei Medical University , ,"
  ],
  "article_type": "systematic review",
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Yize Jia"
    },
    {
      "affs": [
        1
      ],
      "name": "Shan Zhao"
    },
    {
      "affs": [
        0
      ],
      "name": "Xiaohui Wang"
    },
    {
      "affs": [
        2
      ],
      "name": "Shuo Kang"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/b9crv1v37qzng.bib",
  "cited_by": 0,
  "doi": "10.3389/fimmu.2026.1912070",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661560/?tool=EBI",
  "id": "b9crv1v37qzng",
  "issns": [
    "1664-3224"
  ],
  "landing_url": "https://europepmc.org/article/PMC/PMC13661560",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2740|Renal cell carcinoma treatment"
    ]
  ],
  "openalex": "W7214923681",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661560/pdf/?tool=EBI",
  "pmcid": "PMC13661560",
  "pmid": null,
  "published": "2026-09-30",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/b9crv1v37qzng.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:20Z",
      "native_id": "PMC:PMC13661560",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13661560"
    },
    {
      "first_seen": "2026-10-30T12:19:15Z",
      "native_id": "10.3389/fimmu.2026.1912070",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fimmu.2026.1912070/full"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "issn:1664-3224",
      "subfield": "immunology"
    }
  ],
  "title": "First-line immune checkpoint inhibitors combined with targeted therapy for advanced renal cell carcinoma: a network meta-analysis and cost-effectiveness analysis",
  "title_text": "First-line immune checkpoint inhibitors combined with targeted therapy for advanced renal cell carcinoma: a network meta-analysis and cost-effectiveness analysis",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:15Z",
  "url": "https://research.draconitic.com/paper/b9crv1v37qzng",
  "venue": "Frontiers in immunology",
  "versions": []
}