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Renal cell carcinoma pathway model report

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1 Model approach, key assumptions and committee discussion

The evaluation committee used NICE's pilot pathway model approach. This is a single economic model developed by an external assessment group (EAG) evaluating a whole disease area (in this case, renal cell carcinoma [RCC]) and how treatments fit into this. This report is a summary of the committee's decisions about the model starting from first-line treatment of advanced RCC, and is the basis for NICE's draft guidance on cabozantinib with nivolumab for untreated RCC. This model does not cover early-stage or adjuvant treatment for RCC. Email NICE for access to the model and see the committee papers for the EAG's assessment report.

Committee's preferred assumptions for key issues

1.1

The committee's preferred assumptions for the key issues were to:

  • use the state transition model approach (see section 1.6)

  • consider 4 lines of treatment then best supportive care (see section 1.7)

  • use the fractional polynomial network meta-analysis to inform treatment efficacy in the model (see section 1.16)

  • estimate time to stopping treatment and time to next treatment for comparators by applying hazard ratios from the progression-free survival network meta-analyses to the baseline real-world evidence curves for those parameters (see section 1.21)

  • use the adverse events network meta-analyses to model adverse events for comparators (see section 1.25)

  • use the EAG's approach for estimating utility (see section 1.27)

  • use relative dose intensities from published clinical trials (see section 1.29).

See table 1 for a summary of all the committee's preferred assumptions.