Vascular Endothelial Growth Factor Receptor Inhibitors in Chinese Patients With Advanced Radioactive Iodine-Refractory Differentiated Thyroid Cancer: A Network Meta-Analysis and Cost-Effectiveness Analysis

Youwen Zhu; Kun Liu; Kailing Wang; Libo Peng

doi:10.3389/fendo.2022.909333

Vascular Endothelial Growth Factor Receptor Inhibitors in Chinese Patients With Advanced Radioactive Iodine-Refractory Differentiated Thyroid Cancer: A Network Meta-Analysis and Cost-Effectiveness Analysis

Front Endocrinol (Lausanne). 2022 Jul 14:13:909333. doi: 10.3389/fendo.2022.909333. eCollection 2022.

Authors

Youwen Zhu¹, Kun Liu¹, Kailing Wang², Libo Peng³

Affiliations

¹ Department of Oncology, Xiangya Hospital, Central South University, Changsha, China.
² Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China.
³ Department of Oncology, Loudi Central Hospital, The Central Hospital of Loudi Affiliated to the University of South China, Loudi, China.

Abstract

Introduction: Two targeted drugs (apatinib and lenvatinib) show clinical efficacy in first-line treatment of Chinese patients with radioactive advanced iodine-refractory differentiated thyroid cancer (RAIR-DTC) and are recommended by the Chinese Society of Clinical Oncology guidelines. Considering the high clinical cost of long-term vascular endothelial growth factor receptor inhibitor administration and to determine which of the two targeted drugs is preferable, we opted to conduct a cost-effectiveness analysis (CEA) and network meta-analysis (NMA).

Material and methods: The results of NMA and CEA included in the two phase III randomized clinical trials REALITY (NCT03048877) and Study-308 (NCT02966093), in which Bayesian NMA and CEA were performed on 243 and 149 Chinese patients, respectively, were retrieved. Overall survival and progression-free survival (PFS) for apatinib versus lenvatinib were determined by NMA. CEA involved the development of a 20-year Markov model to obtain the total cost and quality-adjusted life-years (QALYs), and this was followed by sensitivity and subgroup analyses.

Results: Compared with lenvatinib, apatinib therapy provided a 0.837 improvement in QALY and $6,975 reduction in costs. The hazard ratio of apatinib versus lenvatinib and the cost of the targeted drugs had a significant impact on the model. According to the sensitivity analysis, apatinib was more cost-effective and had no correlation with willingness-to-pay in China. Subgroup analysis showed that apatinib maintained PFS more economically.

Conclusion: NMA and CEA demonstrated that apatinib was more cost-effective compared to lenvatinib in the first-line treatment of Chinese RAIR-DTC patients.

Keywords: advanced radioactive iodine-refractory differentiated thyroid cancer; apatinib; cost-effectiveness analysis; lenvatinib; network meta-analysis.

Publication types

Meta-Analysis

MeSH terms

Adenocarcinoma* / drug therapy
Bayes Theorem
Cost-Benefit Analysis
Humans
Iodine Radioisotopes / therapeutic use
Network Meta-Analysis
Thyroid Neoplasms* / drug therapy
Thyroid Neoplasms* / radiotherapy
Vascular Endothelial Growth Factor A

Substances

Iodine Radioisotopes
Vascular Endothelial Growth Factor A

Associated data

ClinicalTrials.gov/NCT02966093
ClinicalTrials.gov/NCT03048877