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. 2022 Jun 30:13:860615.
doi: 10.3389/fphar.2022.860615. eCollection 2022.

Cost-Effectiveness of Apatinib and Cabozantinib for the Treatment of Radioiodine-Refractory Differentiated Thyroid Cancer

Bo Shi  1 , Wenbiao Ma  1 , Hongshuai Pan  2 , Yang Shi  3 , Huan Zhang  4 , Shenghai Xing  5
Affiliations

Cost-Effectiveness of Apatinib and Cabozantinib for the Treatment of Radioiodine-Refractory Differentiated Thyroid Cancer

Bo Shi et al. Front Pharmacol. .

Abstract

Background: The effectiveness of apatinib and cabozantinib for the treatment of radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC) has been demonstrated recently. We aimed to evaluate the cost-effectiveness of these treatments from the Chinese healthcare system perspective. Methods: Two partitioned survival models over a 10-year horizon were built to compare the cost and effectiveness of apatinib vs. placebo and cabozantinib vs. placebo based on the clinical data from the phase 3 randomized REALITY and COSMIC-311 trials. Costs and utility data were obtained from the literature and institutional database. The incremental cost-effectiveness ratio (ICER) was calculated. One-way and probabilistic sensitivity analysis was performed to test the robustness of the conclusion. Results: Apatinib yielded an additional quality-adjusted life-year (QALY) of 0.74 at an additional cost of Chinese Renminbi ¥44,077. The ICER was ¥93,460 (US dollar $13545)/QALY and it was below the current willingness-to-pay (WTP) threshold of ¥217341/QALY. Cabozantinib was associated with an additional QALY of 0.79 at an extra cost of ¥3,55,614 when compared with placebo, and the ICER was ¥4,52,325 ($65,554)/QALY, which was above the WTP threshold. The conclusion were robust under one-way and probabilistic sensitivity analysis. The price of cabozantinib has to drop to ¥5.87/mg (39% of the current price) for it has a 50% likelihood of being cost-effective. Conclusion: Apatinib is cost-effective for RAIR-DTC when compared with placebo from the perspective of Chinese healthcare system. However, based on the current evidence, cabozantinib might not be cost-effective and a reduction of price is warranted.

Keywords: China; apatinib; cabozantinib; cost-effective; radioactive iodine-refractory differentiated thyroid cancer.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
The comparison between reconstructed Kaplan-Meier curves from the REALITY and COSMIC-311 trials and the best parametric fitting curves.
FIGURE 2
FIGURE 2
Tornado diagram of one-way sensitivity analyses of apatinib vs. placebo for the treatment of radioactive iodine–refractory differentiated thyroid cancer.
FIGURE 3
FIGURE 3
Tornado diagram of one-way sensitivity analyses of cabozantinib vs. placebo for the treatment of radioactive iodine–refractory differentiated thyroid cancer.
FIGURE 4
FIGURE 4
Cost-effectiveness acceptability curves of apatinib versus placebo for the treatment of radioactive iodine–refractory differentiated thyroid cancer. The square shapes indicate the probability of apatinib being cost-effective when compared with placebo under different willingness-to-pay thresholds.
FIGURE 5
FIGURE 5
Cost-effectiveness acceptability curves of cabozantinib versus placebo for the treatment of radioactive iodine–refractory differentiated thyroid cancer. The square shapes indicate the probability of cabozantinib being cost-effective when compared with placebo under different willingness-to-pay thresholds.
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