scholarly journals A Treatment of Metastatic Renal Cell Carcinoma: The Cost Effectiveness of Axitinib From a Malaysian Perspective

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 71s-71s
Author(s):  
K.A.R. Ku Nurhasni ◽  
J. Sabirin ◽  
S.E. Wan Puteh ◽  
M. Dahlui
Keyword(s):  
Renal Cell Carcinoma ◽  
Cost Effectiveness ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Published Data ◽  
Half Cycle ◽  
Line Treatment ◽  
Second Line ◽  
Discounted Cost

Background: Axitinib has been suggested to be effective as a second line treatment of metastatic renal cell carcinoma. However, its adoption may be limited by its financial consequences. Therefore, a cost-utility analysis was conducted to estimate the economic value of axitinib as a second line treatment of metastatic renal cell carcinoma. Aim: This analysis will informed the decision makers on the potential use of axitinib in this population within the Ministry of Health facilities. Methods: A state transition model was developed using Microsoft Excel 2010 to simulate a hypothetical cohort of patient receiving axitinib or best supportive care over 5 years of time horizon. A monthly cycle was chosen without a half cycle correction. Three health states were included in the model as progression free, disease progression and dead. A 3% discount rate was applied as recommended in the Pharmacoeconomic Guidelines for Malaysia. Total costs were estimated using unit costs from local sources and published data. The clinical and utility parameters were derived from the published literatures. Results: The mean probabilistic incremental discounted cost and QALY for axitinib were RM 113,576.29 and 0.35413 respectively, yielded a probabilistic incremental cost-effectiveness ratio (ICER) of RM 320,719. Unavailability of the local price for axinitib may play a part in the higher estimation of ICER. Conclusion: Axitinib may not be considered as a cost-effective second line treatment of metastatic renal cell carcinoma as the ICER is beyond the value of 3 GDP per capita.

Cost-Effectiveness of Everolimus for Second-Line Treatment of Metastatic Renal Cell Carcinoma in Serbia

2013 ◽  
Vol 35 (12) ◽  
pp. 1909-1922 ◽  
Author(s):  
Jovan Mihajlović ◽  
Petros Pechlivanoglou ◽  
Ana Sabo ◽  
Zdenko Tomić ◽  
Maarten J. Postma
Keyword(s):  
Renal Cell Carcinoma ◽  
Cost Effectiveness ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Line Treatment ◽  
Second Line

scholarly journals An Economic Evaluation of Everolimus As Second Line Treatment of Metastatic Renal Cell Carcinoma: A Malaysian Perspective

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 71s-71s
Author(s):  
K.A.R. Ku Nurhasni ◽  
J. Sabirin ◽  
S.E. Wan Puteh ◽  
M. Dahlui
Keyword(s):  
Renal Cell Carcinoma ◽  
Cost Effectiveness ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Cost Effective ◽  
Best Supportive Care ◽  
Line Treatment ◽  
Second Line ◽  
Cost Effectiveness Threshold

Background: Everolimus as second line treatment of metastatic renal cell carcinoma are significantly effective but more expensive compared with best supportive care alone. Therefore, a cost-utility analysis was needed to inform the decision makers on the potential adoption of everolimus as second line treatment of metastatic renal cell carcinoma weighing by the affordability of the healthcare provider. Aim: To estimate the economic value of everolimus as second line treatment of metastatic renal cell carcinoma. Methods: A state transition model was developed using Microsoft Excel 2010 to simulate a hypothetical cohort of patient receiving everolimus or best supportive care over 5 years time horizon. A monthly cycle was used based on the dosing schedule of everolimus. Three health states were included in the model as progression free, disease progression and dead. A discount rate of 3% was applied as recommended in the Pharmacoeconomic Guidelines for Malaysia. The clinical and utility parameters were derived from the published literatures. Total costs were estimated using unit costs from various local sources and published cost data. Results: Based on 1000 Monte Carlo simulation the mean incremental discounted cost and QALY for everolimus were RM 32,605.28 and 0.35484 respectively, yielded a probabilistic incremental cost-effectiveness ratio (ICER) of RM 91,887. A minimal reduction in the value of ICER was observed when costs associated with adverse events were excluded and variation of price per tablet was explored. Conclusion: Everolimus may be considered a cost-effective strategy at the suggested value of cost-effectiveness threshold by World Health Organization (1-3 gross domestic product (GDP) per capita). However, if the suggested cost-effectiveness threshold for Malaysia is taken into consideration (≤ 1 GDP per capita), this treatment may not be a cost-effective strategy in Malaysia.

scholarly journals Sorafenib as a Second-Line Treatment in Metastatic Renal Cell Carcinoma in Mexico: A Prospective Cohort Study

2021 ◽  
Author(s):  
Ana Elena Martin-Aguilar ◽  
Haidé Nayeli Núñez-López ◽  
Juan C. Ramirez-Sandoval
Keyword(s):  
Renal Cell Carcinoma ◽  
Overall Survival ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Line Treatment ◽  
Second Line ◽  
Sorafenib Treatment ◽  
Sequential Inhibition ◽  
Metastatic Rcc

Abstract Background: Sequential inhibition of the vascular endothelial growth factor (VEGF) pathway with sorafenib could be useful for patients with metastatic renal cell carcinoma (RCC). Our aim was to determine the activity and tolerability of sorafenib as a second-line therapy in advanced RCC initially treated with a different VEGF-tyrosine kinase inhibitor (TKI).Methods: A prospective observational cohort in Mexico (2012–2019). We included 132 subjects with metastatic RCC and who had progression despite treatment with sunitinib. The primary end-point was time to disease progression as evaluated every 12–16 weeks.Results: The mean age of the cohort was 59 years (interquartile range [IQR] 50-72), 96 (73%) were men, and 48 (36%) had a favorable prognosis according to the IMDC (International Metastatic RCC Database Consortium) prognostic model. The median progression-free survival (PFS) and overall-survival after the introduction of sorafenib treatment was 8.6 months (95% confidence interval [CI]: 6.7–10.5) and 40 months (95% CI: 34.5–45.4) respectively. The median overall survival from RCC diagnosis to death was 71 months (95% CI: 58.2–83.8). On multivariable analyses, age >65 years was associated with a longer PFS (HR 0.51; 95% CI: 0.31-0.86; p = 0.018). The median PFS in subjects aged >65 years was longer compared to subjects ≤65 years (14.0 [95% CI: 9.2–18.8] vs. 7.2 months [95% CI: 5.3–9.1]; p = 0.012). Adverse events grade ≥3 associated with sorafenib occurred in 38 (29%) patients.Conclusion: Sequential inhibition of VEGF with sorafenib as a second-line treatment may benefit patients with metastatic RCC, especially in subjects >65 years old.

scholarly journals Cost-Effectiveness Analysis of Sunitinib versus Interferon-Alfa for First-Line Treatment of Advanced and/or Metastatic Renal Cell Carcinoma in Singapore

2019 ◽  
Vol 35 (2) ◽  
pp. 126-133 ◽  
Author(s):  
Sil-ling Pruis ◽  
Mohamed Ismail Abdul Aziz ◽  
Fiona Pearce ◽  
Min Han Tan ◽  
David Bin-Chia Wu ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cost Effectiveness ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Interferon Alfa ◽  
Health State ◽  
Line Treatment ◽  
First Line ◽  
First Line Treatment

AbstractObjectivesThis study was conducted to evaluate the cost-effectiveness of sunitinib versus interferon-alfa for the treatment of advanced and/or metastatic renal cell carcinoma (RCC) in Singapore.MethodsA partitioned survival model with three health states (progression-free, progressive disease, and death) was developed from a healthcare payer perspective over a 10-year time horizon. Survival curves from the pivotal trial of sunitinib versus interferon-alfa were extrapolated beyond the trial period to estimate the underlying progression-free survival and overall survival parametric distributions. Health state utilities were derived from the literature and direct costs were sourced from local public healthcare institutions. The sunitinib dose in the model reflected local prescribing practices whereby a combination of 50 mg (28 percent) and 37.5 mg (72 percent) strengths are used.ResultsThe base-case analysis comparing sunitinib versus interferon-alfa resulted in an incremental cost effectiveness ratio (ICER) of SGD191,061 (USD139,757) per quality-adjusted life-year gained. Sensitivity analysis demonstrated that the ICER was most sensitive to variations in the utility value assumed for the progression-free health state and the price of sunitinib.ConclusionsIn the absence of any price reduction, sunitinib had an exceedingly high ICER and was not considered a cost-effective use of healthcare resources in Singapore's context for the first-line treatment of advanced RCC. The findings from our evaluation will be useful to inform local healthcare decision making and resource allocations for tyrosine kinase inhibitors when appraised alongside comparative clinical effectiveness data and payer affordability considerations.

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