Cost-effectiveness of Pazopanib Versus Sunitinib as First-line Treatment for Locally Advanced or Metastatic Renal Cell Carcinoma from an Italian National Health Service Perspective

• Published in: Clinical therapeutics Vol. 39; no. 3; pp. 567 - 580.e2
• Main Authors: Capri, Stefano, MSc, Porta, Camillo, MD, Delea, Thomas E., MSIA
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2017; Elsevier Limited
• Subjects: Cancer therapies; Carcinoma, Renal Cell - drug therapy; Carcinoma, Renal Cell - pathology; Cost analysis; Cost-Benefit Analysis; cost-effectiveness analysis; Disease-Free Survival; Diuretics; Health; Health services; Humans; Indoles - administration & dosage; Inhibitor drugs; Internal Medicine; Italy; Kidney cancer; Kidney Neoplasms - drug therapy; Kidney Neoplasms - pathology; Medical Education; Metastases; Metastasis; Monte Carlo simulation; Mortality; National Health Programs; partitioned survival analysis; Patients; Pyrimidines - administration & dosage; Pyrroles - administration & dosage; Quality of life; Quality-Adjusted Life Years; Renal cell carcinoma; Sensitivity analysis; Sulfonamides - administration & dosage; Sunitinib; Survival; Survival Analysis; Targeted cancer therapy; Thresholds; utility values; Italy; renal cell carcinoma; cost-effectiveness analysis; partitioned survival analysis; utility values
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/j.clinthera.2017.01.017

Abstract Purpose A prior randomized controlled trial (COMPARZ [Comparing the Efficacy, Safety and Tolerability of Pazopanib versus Sunitinib]) found non-inferior progression-free survival for pazopanib versus sunitinib as first-line therapy in patients with advanced or metastatic renal cell carcinoma. The present study evaluated the cost-effectiveness of pazopanib versus sunitinib as first-line treatment for patients with metastatic renal cell carcinoma from an Italian National Health Service perspective. Methods A partitioned-survival analysis model with 3 health states (progression-free survival, post-progression survival, and dead) was employed. The model time horizon was 5 years. For each treatment strategy, the model generated expected progression-free life years, post-progression life years, overall life years, quality-adjusted life years (QALYs), and costs. Results were reported as incremental costs per QALY gained and the net monetary benefit of pazopanib versus sunitinib. Probabilistic and deterministic sensitivity analyses were conducted to assess the impact on results of methodological and parameter uncertainty. Findings In the base case, pazopanib was associated with higher QALYs and lower costs and dominated sunitinib. Using willingness-to-pay thresholds of €30,000 and €50,000 per QALY, the net monetary benefits with pazopanib were €6508 and €7702 per patient, respectively, versus sunitinib. The probability that pazopanib is cost-effective versus sunitinib was estimated to be 85% at a cost-effectiveness threshold of €20,000, 86% at a threshold of €30,000, and 81% at a threshold of €50,000 per QALY. Results were robust to changes in key parameter values and assumptions. Implications These results suggest that pazopanib is likely to represent a cost-effective treatment option compared with sunitinib as first-line treatment for patients with metastatic renal cell carcinoma in Italy.