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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.rights.license | Atribución-NoComercial-SinDerivadas 4.0 Internacional |
dc.contributor.advisor | Díaz Rojas, Jorge Augusto |
dc.contributor.author | Yepes Hernández, Angie Liceth |
dc.date.accessioned | 2024-01-22T16:08:08Z |
dc.date.available | 2024-01-22T16:08:08Z |
dc.date.issued | 2023-11-29 |
dc.identifier.uri | https://repositorio.unal.edu.co/handle/unal/85391 |
dc.description | ilustraciones, diagramas |
dc.description.abstract | Objetivo: 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) |
dc.description.abstract | 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. |
dc.format.extent | xiv, 88 páginas |
dc.format.mimetype | application/pdf |
dc.language.iso | spa |
dc.publisher | Universidad Nacional de Colombia |
dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/4.0/ |
dc.subject.ddc | 610 - Medicina y salud::615 - Farmacología y terapéutica |
dc.subject.ddc | 330 - Economía |
dc.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 |
dc.type | Trabajo de grado - Maestría |
dc.type.driver | info:eu-repo/semantics/masterThesis |
dc.type.version | info:eu-repo/semantics/acceptedVersion |
dc.publisher.program | Bogotá - Ciencias - Maestría en Ciencias - Farmacología |
dc.contributor.researchgroup | Evaluación Económica de Tecnologías en Salud |
dc.coverage.country | Colombia |
dc.description.degreelevel | Maestría |
dc.description.degreename | Magister en Ciencias - farmacología |
dc.description.researcharea | Farmacoeconomía |
dc.identifier.instname | Universidad Nacional de Colombia |
dc.identifier.reponame | Repositorio Institucional Universidad Nacional de Colombia |
dc.identifier.repourl | https://repositorio.unal.edu.co/ |
dc.publisher.faculty | Facultad de Ciencias |
dc.publisher.place | Bogotá,Colombia |
dc.publisher.branch | Universidad Nacional de Colombia - Sede Bogotá |
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dc.rights.accessrights | info:eu-repo/semantics/openAccess |
dc.subject.lemb | Análisis de volumen-costo-beneficio |
dc.subject.lemb | Break-even analysis |
dc.subject.lemb | Contabilidad de costos |
dc.subject.lemb | Cost accounting |
dc.subject.proposal | Carcinoma de célula renal |
dc.subject.proposal | Evaluación económica |
dc.subject.proposal | Análisis de costo efectividad |
dc.subject.proposal | Nivolumab |
dc.subject.proposal | Ipilimumab |
dc.subject.proposal | Pembrolizumab, |
dc.subject.proposal | Axitinib |
dc.subject.proposal | Sunitinib |
dc.subject.proposal | Renal cell carcinoma |
dc.subject.proposal | Economic evaluation |
dc.subject.proposal | Cost-effectiveness analysis |
dc.subject.proposal | Nivolumab |
dc.subject.proposal | Axitinib |
dc.subject.proposal | Ipilimumab |
dc.subject.proposal | Pembrolizumab |
dc.subject.proposal | Axitinib |
dc.subject.proposal | Sunitinib |
dc.title.translated | A cost-effectiveness analysis of nivolumab + ipilimumab, pembrolizumab + axitinib compared with sunitinib in first-line treatment of metastatic renal cell carcinoma in Colombia |
dc.type.coar | http://purl.org/coar/resource_type/c_bdcc |
dc.type.coarversion | http://purl.org/coar/version/c_ab4af688f83e57aa |
dc.type.content | Text |
dc.type.content | Other |
dc.type.redcol | http://purl.org/redcol/resource_type/TM |
oaire.accessrights | http://purl.org/coar/access_right/c_abf2 |
dcterms.audience.professionaldevelopment | Estudiantes |
dcterms.audience.professionaldevelopment | Investigadores |
dcterms.audience.professionaldevelopment | Público general |
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