First-line immune checkpoint inhibitors combined with targeted therapy for advanced renal cell carcinoma: a network meta-analysis and cost-effectiveness analysis
- 1School of Pharmacy, Hebei Medical University , ,
- 2Department of Oncology, The Second Hospital of Hebei Medical University , ,
- 3Medical Insurance Office, The Second Hospital of Hebei Medical University , ,
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.
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.
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BibTeX
@article{jia2026firstline,
title = {{First-line immune checkpoint inhibitors combined with targeted therapy for advanced renal cell carcinoma: a network meta-analysis and cost-effectiveness analysis}},
author = {Yize Jia and Shan Zhao and Xiaohui Wang and Shuo Kang},
journal = {Frontiers in immunology},
year = {2026},
month = sep,
doi = {10.3389/fimmu.2026.1912070},
url = {https://europepmc.org/article/PMC/PMC13661560},
note = {CC BY},
}
RIS
TY - JOUR
TI - First-line immune checkpoint inhibitors combined with targeted therapy for advanced renal cell carcinoma: a network meta-analysis and cost-effectiveness analysis
AU - Yize Jia
AU - Shan Zhao
AU - Xiaohui Wang
AU - Shuo Kang
PY - 2026
DA - 2026/09/30
JO - Frontiers in immunology
DO - 10.3389/fimmu.2026.1912070
UR - https://europepmc.org/article/PMC/PMC13661560
AB - 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.
SN - 1664-3224
ER -