Cost-effectiveness of rituximab plus CVP for first-line treatment of advanced indolent lymphoma

6583 Background: The addition of rituximab (RTX) to CVP (cyclophosphamide, vincristine, prednisone) in the treatment of advanced follicular lymphoma increases median time to progression by 17 months (15 month v 32 months; p < 0.0001) (Marcus et al, Blood 2005). A societal cost-effectiveness analysis was performed to estimate projected lifetime clinical and economic implications of this treatment. Methods: The cost-effectiveness (CE) of RTX + CVP versus CVP was estimated for a 50 yr old patient. Kaplan-Meier estimates of progression-free and overall survival, up to 4 years, were obtained from the M39021 trial. After 4 years, transition rates from initiation of treatment to progression or death were assumed to be the same in both arms. The clinical and economic implications of relapse and its treatment were included in the model. Incremental costs associated with addition of RTX were estimated using Medicare reimbursement rates and published retail price data. Costs included drug and administration costs, adverse events, treatment of relapses, and end-of-life costs. Utility estimates were derived from the literature and a 3% discount rate was employed. Results: Projected mean overall survival is 1.5 yrs longer for patients assigned to RTX+ CVP versus only CVP (13.7 v 12.2 yrs). The addition of RTX to CVP is estimated to cost an additional $26,439 on average, with an expected gain of 0.85 year of quality-adjusted survival. Over a lifetime, the cost per QALY gained is $31,329. Sensitivity analyses revealed that the variables that most influenced cost-effectiveness were the time horizon (range: $18,800- $31,240) and the unit drug cost of RTX (range: $24,000-$38,000). Conclusion: The model estimates a cost-to-QALY gained ratio that is below that of many treatments used for oncology patients. The use of RTX + CVP for first-line treatment of advanced follicular lymphoma is projected to be cost-effective compared to CVP alone under a range of sensitivity analyses. No significant financial relationships to disclose.

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Cost-Effectiveness Analysis of Atezolizumab Versus Chemotherapy as First-Line Treatment for Metastatic Non-Small-Cell Lung Cancer With Different PD-L1 Expression Status

Frontiers in Oncology ◽

10.3389/fonc.2021.669195 ◽

2021 ◽

Vol 11 ◽

Author(s):

Guoqiang Liu ◽

Shuo Kang ◽

Xinchen Wang ◽

Fangjian Shang

Keyword(s):

Cost Effectiveness ◽

Cost Effective ◽

Sensitivity Analyses ◽

Line Treatment ◽

Wild Type ◽

First Line ◽

Metastatic Nsclc ◽

The Cost ◽

Expression Status ◽

First Line Treatment

BackgroundAtezolizumab could significantly improve clinical outcomes and was associated with less toxicity compared with chemotherapy as the first-line treatment of PD-L1-selected patients with EGFR and ALK wild-type metastatic non-small-cell lung cancer (NSCLC). However, the economic outcomes remain unclear yet in China. This study aimed to investigate the cost-effectiveness of atezolizumab versus chemotherapy as first-line therapy for metastatic NSCLC with different PD-L1 expression status from the Chinese health sector perspective.MethodsA decision-analytic model was conducted to evaluate the economic outcomes for the first-line treatment of EGFR and ALK wild-type metastatic NSCLC with atezolizumab and chemotherapy in high PD-L1 expression, high or intermediate PD-L1 expression and any PD-L1 expression populations, respectively. The efficacy and safety data were obtained from the IMpower110 trial. Cost and utility values were gathered from the local charges and published literatures. Incremental cost-effectiveness ratio (ICER) was estimated. A scenario analysis for a patient assistance program (PAP) was conducted. One-way and probabilistic sensitivity analyses were performed to explore the robustness of the model results.ResultsAtezolizumab yielded additional 0.91 QALYs, 0.57 QALYs, 0.42 QALYs in comparison with chemotherapy, and the ICERs were $123,778.60/QALY, $142,827.19/QALY, $168,902.66/QALY in the high PD-L1 expression, high or intermediate PD-L1 expression, and any PD-L1 expression populations, respectively. When PAP was available, the ICERs were $52,414.63/QALY, $52,329.73/QALY, $61,189.66/QALY in the three categories of PD-L1 expression status populations, respectively. The ICERs were exceed the willingness-to-pay (WTP) threshold of $30,828/QALY (three times of per capita gross domestic product of China in 2019) in China. One-way sensitivity analyses suggested that the cost of atezolizumab played a vital role in the model outcomes, and the probabilistic sensitivity analyses showed atezolizumab was unlikely to be cost-effective at the WTP threshold regardless of PD-L1 expression status and whether the PAP was available or not.ConclusionsAtezolizumab as first-line treatment for PD-L1-selected metastatic NSCLC patients without EGFR mutations or ALK translocations is unlikely to be cost-effective compared with chemotherapy regardless of PD-L1 expression status in the Chinese context.

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Adding Enzalutamide to First-Line Treatment for Metastatic Hormone-Sensitive Prostate Cancer: A Cost-Effectiveness Analysis

Frontiers in Public Health ◽

10.3389/fpubh.2021.608375 ◽

2021 ◽

Vol 9 ◽

Author(s):

Peng-Fei Zhang ◽

Dan Xie ◽

Qiu Li

Keyword(s):

Cost Effectiveness ◽

Cost Effective ◽

Sensitivity Analyses ◽

Line Treatment ◽

First Line ◽

Effectiveness Analysis ◽

The Us ◽

Hormone Sensitive ◽

The Cost ◽

First Line Treatment

Background: The aim of this study is to evaluate the pharmacoeconomic profile of adding enzalutamide to first-line treatment for metastatic, hormone-sensitive prostate cancer (mHSPC) from the US and Chinese payers' perspectives.Materials and Methods: A Markov model with three health states: progression-free survival (PFS), progressive disease (PD), and death, was constructed. All patients were assumed to enter the model in the PFS state and transit according to the transition structure. Efficacy data were derived from the ENZAMET trial and Weibull distribution curves were modeled to fit the survival curves. Costs in the model included cost of drugs, best-supportive care (BSC), follow-up, tests, and adverse events (AEs)-related treatments. The primary endpoint of the study was incremental cost-effectiveness ratio (ICER). In addition, the impact of several key parameters on the results of the cost-effectiveness analysis was tested with one-way sensitivity analyses and probabilistic sensitivity analyses.Results: Overall, ICERs were $430,933.95/QALY and $225,444.74/QALY of addition of enzalutamide to androgen deprivation therapy (ADT) vs. ADT from the US and Chinese payers' perspective, respectively. The most influential factors were the utility for the PFS state and the cost of enzalutamide. At the willingness-to-pay (WTP) thresholds of $100,000.00/QALY in the US and $28,988.40/QALY in China, the probability of adding enzalutamide to first-line treatment being a cost-effective option for mHSPC was 0%.Conclusions: Based on the data from the ENZAMET trial and the current price of enzalutamide, adding enzalutamide to first-line treatment is not cost-effective for patients with mHSPC from the US and Chinse payers' perspectives.

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First-Line Pembrolizumab Plus Chemotherapy for Extensive-Stage Small-Cell Lung Cancer: A Cost-Effectiveness Analysis

10.21203/rs.3.rs-725799/v1 ◽

2021 ◽

Author(s):

Youwen Zhu ◽

Huabin Hu ◽

Dong Ding ◽

Shuosha Li ◽

Mengting Liao ◽

...

Keyword(s):

Cost Effectiveness ◽

Cost Effective ◽

Small Cell ◽

Sensitivity Analyses ◽

Small Cell Lung ◽

First Line ◽

The Us ◽

Extensive Stage ◽

The Cost ◽

First Line Treatment

Abstract Background：The phase III clinical trial Keynote-604 indicated that pembrolizumab plus chemotherapy could generate clinical benefits in Extensive-Stage Small-Cell Lung Cancer (ES-SCLC). We aim to evaluate the cost-effectiveness of pembrolizumab plus chemotherapy as the first-line treatment of ES-SCLC from the United States (US) payers’ perspective.Methods: A synthetical Markov model was used to evaluate cost and effectiveness of pembrolizumab plus platinum-etoposide (EP) versus EP in first-line therapy for ES-SCLC from the data of Keynote-604. Lifetime costs life-years (LYs), quality adjusted LYs (QALYs), and incremental cost-effectiveness ratios (ICERs) were estimated. One-way and probabilistic sensitivity analyses were performed. In addition, We also considered subgroup cost-effectiveness.Results: Pembrolizumab plus EP resulted in additional 0.18 QALYs (0.32 LYs) and corresponding incremental costs $113,625, resulting an ICER of $647,509 per QALY versus EP. The most influential factor in this model was the cost of pembrolizumab. Probabilistic sensitivity analysis showed there was 0% probability that pembrolizumab combination chemotherapy was cost-effective at willingness-to-pay (WTP) values of $150,000 per QALY in the US. The results of subgroup probabilistic sensitivity analyses suggested that all subgroups were not cost-effective.Conclusion: From the perspective of the US payer, pembrolizumab plus EP is not a cost-effective option as first-line treatment for patients with ES-SCLC at a WTP threshold of $150,000 per QALY.

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Cost-effectiveness analysis of first-line treatment for metastatic renal cell carcinoma (mRCC) in Colombia (ONCOLGroup study)

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e16150 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e16150-e16150

Author(s):

J. Godoy ◽

A. F. Cardona ◽

H. Cáceres ◽

J. M. Otero ◽

M. Lujan ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cost Effectiveness ◽

Renal Cell ◽

Cost Effective ◽

Average Total Cost ◽

Line Treatment ◽

First Line ◽

Total Cost ◽

The Cost ◽

First Line Treatment

e16150 Background: Renal cell carcinoma has increased its incidence by 126% since 1950. A local study developed a complete economic evaluation of sunitinib versus IFN in first-line treatment of mRCC in Colombia, finding that sunitinib was more cost-useful and cost-effective. Methods: A Markov model was developed using 6-week cycles for evaluating the cost-effectiveness of four interventions (IFN, sunitinib, bevacizumab+IFN, sorafenib) approved as first-line treatment for mRCC in Colombia. The model used the third-party payer perspective and a 5-year time-line; it also presumed that all the patients (pts) continued with active treatment until progression when it became acceptable to continue with a second-line treatment or BSC. Overall survival (OS) and progression-free survival (PFS) curves of IFN were used as reference framework; they were obtained form a published clinical trial. The hazard ratios (HR) for PFS and OS were estimated for comparing new generation medicaments with IFN. The information about frequency of use and health service cost units consumed in Colombia was taken from a series of 24 pts treated in Manizales, Pereira, Medellín and Bogotá. Service costs were requested from an external consultant and corresponded to the average value billed by the EPSs, calculated from 33 sources of information which were representative of the country's market. The cost of the medicaments was obtained from LCLC. The costs and benefits were discounted annually at 3%. (all cost are presented in Colombian pesos Col$ 2008 with an exchange rate 1 USD = 1836.20 Col$). Results: Incremental analysis indicated a difference of 41.1 million Col$ in the average total cost of treatment when Sunitinib was compared to IFN; in contrast, comparing sorafenib and Bevacizumab+INF to sunitinib demonstrated that the average total cost was less for the sunitinib by 8.3 and 104.2 million Col$, respectively. Additionally, the ratios of incremental cost-effectiveness by life years (LY) gained demonstrated sunitinib's simple dominance over sorafenib and the combination of bevacizumab+IFN, and an average by LY gained of 100.5 million Col$ compared to IFN. Conclusions: Sunitinib is the most cost-effective option as first-line treatment for mRCC pts in Colombia. [Table: see text]

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Cost Effectiveness of First-Line Treatment with Doxorubicin/Ifosfamide Compared to Trabectedin Monotherapy in the Management of Advanced Soft Tissue Sarcoma in Italy, Spain, and Sweden

Sarcoma ◽

10.1155/2013/725305 ◽

2013 ◽

Vol 2013 ◽

pp. 1-19 ◽

Cited By ~ 6

Author(s):

Julian F. Guest ◽

Monica Panca ◽

Erikas Sladkevicius ◽

Nicholas Gough ◽

Mark Linch

Keyword(s):

Cost Effectiveness ◽

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Cost Effective ◽

Line Treatment ◽

First Line ◽

Advanced Soft Tissue Sarcoma ◽

Effective Use ◽

The Cost ◽

First Line Treatment

Background. Doxorubicin/ifosfamide is a first-line systemic chemotherapy for the majority of advanced soft tissue sarcoma (ASTS) subtypes. Trabectedin is indicated for the treatment of ASTS after failure of anthracyclines and/or ifosfamide; however it is being increasingly used off-label as a first-line treatment. This study estimated the cost effectiveness of these two treatments in the first-line management of ASTS in Italy, Spain, and Sweden.Methods. A Markov model was constructed to estimate the cost effectiveness of doxorubicin/ifosfamide compared to trabectedin monotherapy, defined as the cost per QALY gained, in each country.Results. First-line treatment with doxorubicin/ifosfamide resulted in lower two-year healthcare costs and more QALYs than first-line treatment with trabectedin monotherapy in all three countries. Probabilistic sensitivity analysis showed that at a cost per QALY threshold of €35,000, >90% of a cohort would be cost effectively treated with doxorubicin/ifosfamide compared to trabectedin monotherapy in all three countries.Conclusion. Within the model’s limitations, first-line treatment of patients with ASTS with doxorubicin/ifosfamide instead of trabectedin monotherapy affords a cost-effective use of publicly funded healthcare resources in Italy, Spain, and Sweden and is therefore the preferred treatment in all three countries. These findings support the recommendation that trabectedin should remain a second-line treatment.

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The Cost-Effectiveness of Lenvatinib in the Treatment of Advanced or Unresectable Hepatocellular Carcinoma from a Canadian Perspective

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2021/8811018 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Brandon M. Meyers ◽

Arndt Vogel ◽

Paul Marotta ◽

Petr Kavan ◽

Laveena Kamboj ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Cost Effectiveness ◽

Phase Iii ◽

Line Treatment ◽

First Line ◽

Unresectable Hepatocellular Carcinoma ◽

Canadian Perspective ◽

The Cost ◽

First Line Treatment

Lenvatinib is an oral multikinase inhibitor indicated for the first-line treatment of unresectable hepatocellular carcinoma (uHCC). In the Phase III REFLECT trial, lenvatinib was noninferior in the primary endpoint of overall survival versus sorafenib, the only systemic therapy funded in Canada prior to the introduction of lenvatinib. Lenvatinib also demonstrated statistically significant improvement compared to sorafenib in secondary endpoint progression-free survival, time to progression, and objective response rate. The aim of this analysis was to estimate the cost-effectiveness of lenvatinib versus sorafenib for the first-line treatment of patients with uHCC from a Canadian perspective. A cost-utility analysis was conducted using partitioned survival modelling, with health states representing progression-free disease, progressed disease, and death. Health effects were measured using quality-adjusted life years (QALYs), and costs were represented in Canadian dollars. Clinical inputs were derived from the REFLECT trial, with outcomes extrapolated using parametric survival models. EQ-5D data collected in REFLECT were used to determine health state utility values, and estimates of resource use came from a survey of clinicians. The model predicted incremental costs of-$5,021 and incremental QALYs of 0.17, making lenvatinib dominant over sorafenib. The model demonstrates lenvatinib to be a cost-effective use of resources versus sorafenib in Canada for the treatment of uHCC. Overall costs are lower compared with sorafenib, while health benefits are greater, with modelled progression-free and overall survival extended by 4.1 and 2.6 months in the lenvatinib arm, respectively.

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Cost-effectiveness Analysis of Caspofungin and Fluconazole for Primary Treatment of Invasive Candidiasis and Candidemia in Ethiopia

10.21203/rs.3.rs-1214746/v1 ◽

2022 ◽

Author(s):

Gebremedhin Beedemariam Gebretekle ◽

Atalay Mulu Fentie ◽

Girma Tekle Gebremariam ◽

Eskinder Eshetu Ali ◽

Daniel Asfaw Erku ◽

...

Keyword(s):

Cost Effectiveness ◽

Invasive Candidiasis ◽

Cost Effective ◽

Primary Treatment ◽

Line Treatment ◽

Second Line ◽

First Line ◽

System Perspective ◽

The Cost ◽

First Line Treatment

Abstract Background: Caspofungin was shown to be more effective than fluconazole in treating patients with invasive candidiasis and/or candidaemia (IC/C). However, cost-effectiveness of caspofungin for treating IC/C in Ethiopia remains unknown. We aimed to assess the cost-effectiveness of caspofungin compared to fluconazole as primary treatment of IC/C in Ethiopia.Methods: A Markov cohort model was developed to compare the cost-utility of caspofungin versus fluconazole antifungal agents as first-line treatment for adult inpatients with IC/C from the Ethiopian health system perspective. Treatment outcome was categorized as either a clinical success or failure, with clinical failure being switched to a different antifungal medication. Liposomal amphotericin B (L-AmB) was used as a rescue agent for patients who had failed caspofungin treatment, while caspofungin or L-AmB were used for patients who had failed fluconazole treatment. Primary outcomes were expected quality-adjusted life years (QALYs), costs (US$2021), and the incremental cost-effectiveness ratio (ICER). QALYs and costs were discounted at 3% annually. Cost data was obtained from Addis Ababa hospitals while locally unavailable data were derived from the literature. Cost-effectiveness was assessed against the recommended threshold of 50% of Ethiopia’s gross domestic product/capita. Deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of the findings.Results: In the base-case analysis, treatment of IC/C with caspofungin as first-line treatment resulted in better health outcomes (12.86 QALYs) but higher costs (US$7,714) compared to fluconazole-initiated treatment followed by caspofungin (12.30 QALYs; US$3,217) or L-AmB (10.92 QALYs; US$2,781) as second-line treatment. Caspofungin as primary treatment for IC/C was not cost-effective when compared to fluconazole-initiated therapies. Fluconazole-initiated treatment followed by caspofungin was cost-effective for the treatment of IC/C compared to fluconazole with L-AmB as second-line treatment, at US$316/QALY gained. Our findings were sensitive to medication costs, drug effectiveness, infection recurrence, and infection-related mortality rates. Probabilistic sensitivity analysis confirmed the stability of our findings.Conclusions: Our study showed that the use of caspofungin as primary treatment for IC/C in Ethiopia was not cost-effective when compared with fluconazole-initiated treatment alternatives. The findings supported the use of fluconazole-initiated therapy with caspofungin as a second-line treatment to treat IC/C in Ethiopia and other low-income countries.

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Cost-Effectiveness of Imatinib in Comparison with Bone Marrow Transplant in Chronic Phase (CP) Chronic Myeloid Leukaemia (CML) in China.

Blood ◽

10.1182/blood.v114.22.2474.2474 ◽

2009 ◽

Vol 114 (22) ◽

pp. 2474-2474

Author(s):

Zhixiang Shen ◽

Xiaojun Huang ◽

Samara Mendes de Costa ◽

Zi Chen ◽

Xiaoping Xu ◽

...

Keyword(s):

Bone Marrow ◽

Overall Survival ◽

Cost Effectiveness ◽

Chinese Population ◽

Line Treatment ◽

Survival Curves ◽

First Line ◽

Life Years ◽

The Cost ◽

First Line Treatment

Abstract Abstract 2474 Poster Board II-451 Background Imatinib is associated with significant long-term survival benefits in CP CML patients versus bone marrow transplantation (BMT). Despite the proven benefits of imatinib and its position in first line treatment of chronic CML in several countries, BMT remains a treatment option in first line treatment of CML China. This modelling study was designed to explore the cost-effectiveness of imatinib in the Chinese setting. Methods A model was built in Microsoft Excel, with quarterly time intervals for overall survival over a 2-year period due to the lack of longer term follow up cost data for BMT. Published survival curves for the Chinese population were not available for either imatinib or BMT; however survival data for both imatinib and BMT from previous published literature were found to be broadly consistent with those reported in an unpublished survival meta-analysis of imatinib and BMT in Chinese population. The overall survival curve for imatinib sourced from the IRIS study (Druker et al 2006) was reconstructed in order to populate the imatinib arm of the model, and transplantation survival curves from Hasford et al (ASH 2008) were used to populate the BMT arm in the model. It was assumed that all patients surviving in each cycle remained in remission. Costs were based on the Chinese payment system. Due to the lack of publicly available cost data in China, a retrospective analysis of patient billings was conducted in 3 top tier hospitals in China (2 in Shanghai and 1 in Beijing) using a paper-based data collection questionnaire, with a target of 60 patients in total. Costs included in the model were: average cost of transplantation (including pre-operative and post-operative care and the transplantation procedure, as well as donor costs), complications associated with BMT and imatinib, quarterly cost of imatinib to the patients, and average quarterly charges for tests and monitoring. Utilities used in the model were sourced from IRIS; the utility for imatinib patients in remission was 0.854. Due to lack of published utility values in BMT patients, it was assumed that transplantation patients in remission would experience the same utility as interferon plus low-dose cytarabine (0.71). The outcomes of the model were total costs of treatment, life years, quality adjusted life years (QALY). A discount rate of 5% was used for costs and 0% for outcomes (utilities and life-years). Results Based on a cohort of 500 patients in each arm, the use of imatinib in CP CML yielded 497 and 971 life years (424 and 829 QALYs) at 1 and 2 years for imatinib vs. 485 and 898 for BMT (345 and 637 QALYs). Incremental life years (QALYs) were 12 (80) and 73 (192) at 1 and 2 years comparing imatinib with BMT. Total costs for imatinib were 73,194,400 RMB and 143,380,400 RMB at 1 and 2 years vs. 134,789,745 RMB and 143,552,071 RMB for BMT. Therefore, the cost savings for imatinib vs. BMT were 61,595,345 RMB and 171,671 RMB at 1 and 2 years. Imatinib is a dominant strategy to BMT (i.e., lower cost and higher efficacy) at 1 and 2 years. The model results were most sensitive to varying costs of BMT and discounting rates. Conclusion The results of the model demonstrate that imatinib is associated with improved overall survival and lower costs compared with BMT for the first 2 years in treating CP CML patients in the Chinese setting. Imatinib should be the first line treatment in CP CML based on both clinical and economic evidence. Disclosures: No relevant conflicts of interest to declare.

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Cost-effectiveness of pazopanib as first-line treatment of metastatic renal cell carcinoma from National Health Service United Kingdom perspective.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e16088 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e16088-e16088

Author(s):

Barbara Elizabeth Ratto ◽

Ankur Khare ◽

Kapil Gudala ◽

Praveen Gunda

Keyword(s):

Renal Cell Carcinoma ◽

Sensitivity Analysis ◽

Cost Effectiveness ◽

National Health Service ◽

Time Horizon ◽

Cost Effective ◽

Line Treatment ◽

First Line ◽

The Cost ◽

First Line Treatment

e16088 Background: Recently, several therapies have been approved for treatment of metastatic renal cell carcinoma (mRCC) in the United Kingdom (UK); however, there is scarcity of comparative evidence to assist treatment decisions. We evaluated the cost-effectiveness of pazopanib as first-line treatment of mRCC from a UK National Health Service perspective. Methods: A partitioned-survival analysis model with 3 health states (alive with no progression, alive with progression, or dead) was used to evaluate the cost-effectiveness of pazopanib compared to sunitinib, tivozanib and cabozantinib in treatment-naive mRCC patients with treatment cycle length of 1 week and time horizon of 10 years. The model was populated with clinical effectiveness data obtained from network meta-analysis of pivotal trials and data on costs and utilities collected from UK-specific resources. The key model outcomes were quality-adjusted life years (QALY) and incremental cost-effectiveness ratio (ICER). Probabilistic and one-way sensitivity analyses were performed to test the uncertainty regarding model results. Results: Base-case analysis found that pazopanib was dominant (i.e. less costly and more effective) compared to sunitinib and tivozanib. Pazopanib had lower total costs (£69,861 vs £71,398 and £73,530) and higher QALYs (1.901 vs 1.835 and 1.669, respectively) compared to sunitinib and tivozanib. When compared with cabozantinib, pazopanib was found to be less costly (£174,735 vs £69,861) and less effective (total QALYs, 2.213 vs 1.901, respectively). Results of the probabilistic sensitivity analysis showed that at a willingness-to-pay (WTP) threshold of £30,000 per QALY, the probability of pazopanib being cost-effective was highest as compared to all comparators (84% vs sunitinib, 98% vs tivozanib and 100% vs cabozantinib). One-way sensitivity analysis revealed that effectiveness inputs, time horizon and others are model influencers. Conclusions: Based on a WTP threshold of £30,000/QALY gained, pazopanib is the most cost-effective treatment option compared to sunitinib, tivozanib and cabozantinib, for mRCC patients in UK.

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Economic Evaluation of Sunitinib Malate for the First-Line Treatment of Metastatic Renal Cell Carcinoma

Journal of Clinical Oncology ◽

10.1200/jco.2007.13.2662 ◽

2008 ◽

Vol 26 (24) ◽

pp. 3995-4000 ◽

Cited By ~ 58

Author(s):

Edit Remák ◽

Claudie Charbonneau ◽

Sylvie Négrier ◽

Sindy T. Kim ◽

Robert J. Motzer

Keyword(s):

Renal Cell Carcinoma ◽

Cost Effectiveness ◽

Cost Utility ◽

Sensitivity Analyses ◽

Line Treatment ◽

First Line ◽

Sunitinib Malate ◽

Life Years ◽

The Cost ◽

First Line Treatment

Purpose To assess the cost effectiveness and cost utility of sunitinib malate as a first-line treatment in metastatic renal cell carcinoma (mRCC) compared with interferon-alfa (IFN-α) and interleukin-2 (IL-2) from a US societal perspective. Methods A Markov model was developed to simulate disease progression and to determine progression-free survival, total life-years (LYs), and quality-adjusted life-years (QALYs) gained. Model parameters were derived from the pivotal trial of sunitinib, published literature, government sources, and clinical experts’ opinions. The model included trial-based adverse events (AEs). Costs of drug treatment, routine follow-up, AEs, disease progression, and best supportive care (BSC) of terminally ill patients were included. Results were tested using probabilistic and deterministic sensitivity analyses. Results Treatment with sunitinib is associated with a gain in progression-free years of 0.41 and 0.35 over IFN-α and IL-2. The estimated gains over IFN-α were 0.11 LYs and 0.14 QALYs, and over IL-2 were 0.24 LYs and 0.20 QALYs. Both IFN-α and sunitinib treatments dominate IL-2 treatment; the incremental cost-effectiveness ratio of sunitinib versus IFN-α was $18,611 per progression-free year gained and $67,215 per LY gained, and the cost-utility ratio is $52,593 per QALY gained (at a 5% discount rate). Sensitivity analyses found the results to be most sensitive to utility values during treatment, the cost of sunitinib, and the cost of BSC. Model results were robust to changes in other model variables. Conclusion These results suggest that sunitinib is a cost-effective alternative to IFN-α as a first-line treatment for mRCC.

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