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

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 yen 44,077. The ICER was yen 93,460 (US dollar $13545)/QALY and it was below the current willingness-to-pay (WTP) threshold of yen 217341/QALY. Cabozantinib was associated with an additional QALY of 0.79 at an extra cost of yen 3,55,614 when compared with placebo, and the ICER was yen 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 yen 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.

Automated summary

This study evaluated the cost-effectiveness of apatinib and cabozantinib for RAIR-DTC from the perspective of the Chinese healthcare system. The results showed that apatinib is cost-effective compared to placebo, while cabozantinib may not be cost-effective and a reduction in price is warranted.