Cost-Effectiveness of Sorafenib for Second-Line Treatment of Advanced Renal Cell Carcinoma

• Published in: Value in health Vol. 13; no. 1; pp. 55 - 60
• Main Authors: Hoyle, Martin, PhD, Green, Colin, PhD, Thompson-Coon, Jo, PhD, Liu, Zulian, BA, Welch, Karen, BA, Moxham, Tiffany, MSc, Stein, Ken, MRCGP, FFPH, PhD
• Format: Journal Article
• Language: English
• Published: Malden, USA Elsevier Inc 2010; Blackwell Publishing Inc
• Subjects: Antineoplastic Agents - economics; Antineoplastic Agents - therapeutic use; Benzenesulfonates - economics; Benzenesulfonates - therapeutic use; Carcinoma, Renal Cell - drug therapy; Carcinoma, Renal Cell - economics; Chemotherapy, Adjuvant - economics; Clinical effectiveness; Cost effectiveness; Cost-Benefit Analysis; cost-utility; decision analytic modeling; Decision Support Techniques; Disease Progression; Health; Humans; Internal Medicine; Kidney cancer; Kidney Neoplasms - drug therapy; Kidney Neoplasms - economics; Markov Chains; Medicin och hälsovetenskap; Models, Statistical; National Health Programs; Nexavar; Niacinamide - analogs & derivatives; Phenylurea Compounds; Pyridines - economics; Pyridines - therapeutic use; Quality adjusted life years; renal cell carcinoma; Sensitivity analysis; sorafenib; United Kingdom; cost-effectiveness; decision analytic modeling; renal cell carcinoma; cost-utility; sorafenib; Nexavar
• ISSN: 1098-3015; 1524-4733; 1524-4733
• DOI: 10.1111/j.1524-4733.2009.00616.x

Abstract Objectives To estimate the cost-effectiveness of sorafenib (Nexavar, Bayer, Leverkusen, Germany) versus best supportive care (BSC) for second-line treatment of advanced renal cell carcinoma from the perspective of the UK National Health Service. Methods A decision analytic model was developed to estimate the cost-effectiveness of sorafenib. The clinical effectiveness of sorafenib versus BSC was taken from a recent randomized phase III trial. Utility values were taken from a phase II trial of sunitinib, using EQ-5D tariffs. Cost data were obtained from published literature and were based on current UK practice. The effect of parameter uncertainty on cost-effectiveness was explored through extensive one-way and probabilistic sensitivity analyses. Results Compared to BSC, sorafenib treatment resulted in an incremental cost per quality-adjusted life year (QALY) gained of £75,398, based on an estimated mean gain of 0.27 QALYs per patient, at a mean additional cost of £20,063 (inflated to 2007/2008). The probability that sorafenib is cost-effective compared to BSC at a willingness to pay threshold of £30,000 per QALY is 0.0%. In sensitivity analysis, estimates of cost per QALY were sensitive to changes in the clinical effectiveness parameters, and to health state utilities and drug costs. Conclusions Sorafenib has been shown to be clinically effective compared to BSC, offering additional health benefits; however, with a cost per QALY in excess of £70,000, it may not be regarded as a cost-effective use of resources in some health-care settings.