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Systematic review and mixed-
treatment comparison (MTC)
CONCLUSIONS:
The RCT evidence suggests that cabozantinib is likely to be the most effective for PFS and OS, closely followed by
nivolumab. All treatments appear to delay disease progression and prolong survival compared with BSC,
although the results are heterogeneous. The economic analysis shows that at list price everolimus could be
recommended as the other drugs are much more expensive with insufficient incremental benefit. The
applicability of these findings to the NHS is somewhat limited because existing confidential patient access
schemes could not be used in the analysis. Future work using the discounted prices at which these drugs are
provided to the NHS would better inform estimates of their relative cost-effectiveness