Economic evaluation of new targeted therapies for the first‐line treatment of patients with metastatic renal cell carcinoma

• Published in: BJU international Vol. 108; no. 5; pp. 665 - 672
• Main Authors: Benedict, Ágnes, Figlin, Robert A., Sandström, Per, Harmenberg, Ulrika, Ullén, Anders, Charbonneau, Claudie, Sandin, Rickard, Remák, Edit, Hariharan, Subramanian, Négrier, Sylvie
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.09.2011; Wiley-Blackwell
• Subjects: Antibodies, Monoclonal - economics; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized; Antineoplastic Agents - economics; Antineoplastic Agents - therapeutic use; Benzenesulfonates - economics; Benzenesulfonates - therapeutic use; Bevacizumab; Biological and medical sciences; Carcinoma, Renal Cell - drug therapy; Carcinoma, Renal Cell - economics; Carcinoma, Renal Cell - mortality; Carcinoma, Renal Cell - secondary; cost effectiveness; Cost-Benefit Analysis; Disease Progression; Drug Costs; Female; Humans; Indoles - economics; Indoles - therapeutic use; Interferon-alpha - economics; Interferon-alpha - therapeutic use; Kidney Neoplasms - drug therapy; Kidney Neoplasms - economics; Kidney Neoplasms - mortality; Kidney Neoplasms - pathology; Kidneys; Male; Markov Chains; Medical sciences; Medicin och hälsovetenskap; Molecular Targeted Therapy - economics; Nephrology. Urinary tract diseases; Niacinamide - analogs & derivatives; Phenylurea Compounds; Pyridines - economics; Pyridines - therapeutic use; Pyrroles - economics; Pyrroles - therapeutic use; Quality-Adjusted Life Years; renal cell carcinoma; sunitinib; Sweden; targeted therapy; Tumors of the urinary system; United States; Antineoplastic agent; Nephrology; Carcinoma; Targeted therapy; Metastasis; Urology; Sunitinib; Grawitz tumor; Advanced stage; Antiangiogenic agent; Protein-tyrosine kinase; Cost efficiency analysis; Kidney disease; Human; Urinary system disease; Enzyme; Tyrosine kinase inhibitor; Transferases; Enzyme inhibitor; Malignant tumor; First line treatment; renal cell carcinoma; Health economy; Kidney cancer; cost effectiveness; Metastatic; Multikinase inhibitor; Cancer
• ISSN: 1464-4096; 1464-410X; 1464-410X
• DOI: 10.1111/j.1464-410X.2010.09957.x

Study Type – Therapy (economic) Level of Evidence 2b What’s known on the subject? and What does the study add? Cost‐effectiveness of new targeted molecular therapies in patients with mRCC have been examined compared to interferon‐α. This study compares cost‐effectiveness of three new targeted therapies in mRCC head‐to‐head based on indirect comparison of clinical efficacy. The study shows that sunitinib is a cost‐effective therapy in first line treatment for patients with mRCC in the USA and Sweden compared to sorafenib and bevacizumab+interferon‐α. OBJECTIVE • To assess the economic value of targeted therapies as first‐line metastatic renal cell carcinoma (mRCC) treatment in the US and Sweden by indirect comparison of survival data. METHODS • A Markov model simulated disease progression, adverse events and survival with sunitinib vs sorafenib in the US and bevacizumab plus interferon‐α (IFN‐α) in both countries. • Results, in life‐years (LYs), progression‐free LYs (PFLYs), quality‐adjusted LYs (QALYs) gained and treatment costs (2008 USD) were obtained through deterministic and probabilistic analyses over the patient’s lifetime. RESULTS • Sunitinib was more effective and less costly than sorafenib (gains of 0.52 PFLYs, 0.16 LYs and 0.17 QALYs and savings/patient of $13 576 in the US) and bevacizumab plus IFN‐α (gains of 0.19 PFLYs, 0.23 LYs and 0.16 QALYs in both countries and savings/patient of $67 798 and $47 264 in the US and Sweden, respectively). • Results were most influenced by hazard ratios for progression‐free and overall survival and treatment costs, making results generalizable across other countries if relative costs were to fall within the ranges of those in the US and Sweden. CONCLUSION • The present analyses suggest that first‐line mRCC treatment with sunitinib is a cost‐effective alternative to sorafenib and bevacizumab plus IFN‐α.