转化为简体中文并保持原句结构：转移性肾细胞癌（mRCC）的治疗格局在近年来发生了显著变化。在没有直接比较试验的情况下，成本效益（CE）等因素对指导决策至关重要。评估指南推荐的一线和二线治疗方案的CE。通过建立综合Markov模型，分析当前五种国家肿瘤综合网网络推荐的一线治疗及其适当的二线治疗对具有国际转移性RCC数据库协作组良好和中等/差劲风险的患者群体的CE。估计使用每QALY 15万美元的愿意支付门槛的寿命年，调整后的寿命年和总累计成本。进行单向和概率敏感性分析。在良好风险人群中，Pembrolizumab + Lenvatinib随后是Cabozantinib增加了$32,935的成本，产生了0.28个QALY，与Pembrolizumab + Axitinib随后与Cabozantinib相比，产生了117625美元每QALY的增量CE比率（ICER）。在中等/差劲风险人群中，尼伐单抗+伊匹单抗随后是Cabozantinib增加了$2252的成本，产生了0.60个QALY，与Cabozantinib随后与尼伐单抗相比，产生了4184美元的ICER。限制包括治疗之间的中位随访期差异。对于良好风险的患者，Pembrolizumab + Lenvatinib随后是Cabozantinib和Pembrolizumab + Axitinib随后是Cabozantinib是成本效益的治疗方案。对于中等/差劲风险的患者，尼伐单抗+伊匹单抗随后是Cabozantinib是成本效益最高的治疗方案，并在所有首选治疗中占优势。因为新的肾癌治疗尚未进行头对头的比较，所以比较它们的成本和效果有助于决定最佳的首选治疗方法。我们的模型表明，具有良好风险概况的患者最有可能从Pembrolizumab和Lenvatinib或Axitinib随后是Cabozantinib中获益，而具有中等或差劲风险概况的患者最有可能从Nivolumab和Ipilimumab随后是Cabozantinib中获益。版权所有©2023年欧洲泌尿外科协会。保留所有权利。

The treatment landscape for metastatic renal cell carcinoma (mRCC) has significantly evolved in recent years. Without direct comparator trials, factors such as cost effectiveness (CE) are important to guide decision-making.To assess the CE of guideline-recommended approved first- and second-line treatment regimens.A comprehensive Markov model was developed to analyze the CE of the five current National Comprehensive Cancer Network-recommended first-line therapies with appropriate second-line therapy for patient cohorts with International Metastatic RCC Database Consortium favorable and intermediate/poor risk.Life years, quality-adjusted life years (QALYs), and total accumulated costs were estimated using a willingness-to-pay threshold of $150 000 per QALY. One-way and probabilistic sensitivity analyses were performed.In patients with favorable risk, pembrolizumab + lenvatinib followed by cabozantinib added $32 935 in costs and yielded 0.28 QALYs, resulting in an incremental CE ratio (ICER) of $117 625 per QALY in comparison to pembrolizumab + axitinib followed by cabozantinib. In patients with intermediate/poor risk, nivolumab + ipilimumab followed by cabozantinib added $2252 in costs and yielded 0.60 QALYs compared to cabozantinib followed by nivolumab, yielding an ICER of $4184. Limitations include differences in median follow-up duration between treatments.Pembrolizumab + lenvatinib followed by cabozantinib, and pembrolizumab + axitinib followed by cabozantinib were cost-effective treatment sequences for patients with favorable-risk mRCC. Nivolumab +ipilimumab followed by cabozantinib was the most cost-effective treatment sequence for patients with intermediate-/poor-risk mRCC, dominating all preferred treatments.Because new treatments for kidney cancer have not been compared head to head, comparison of their cost and efficacy can help in making decisions about the best treatments to use first. Our model showed that patients with a favorable risk profile are most likely to benefit from pembrolizumab and lenvatinib or axitinib followed by cabozantinib, while patients with an intermediate or poor risk profile will probably benefit most from nivolumab and ipilimumab followed by cabozantinib.Copyright © 2023 European Association of Urology. All rights reserved.