Bevacizumab, sorafenib tosylate, sunitinib and temsirolimus for renal cell carcinoma: a systematic review and economic evaluation

Abstract

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Cost effectiveness in practice and its effect on clinical outcomes

“…In essence, there only exist two studies of the cost-effectiveness of sunitinib, the company study PenTAG and the HTA study used for the NICE technology appraisal [11]. Estimates from the PenTAG model suggested that none of the interventions would be considered cost-effective at a willingness-to-pay threshold of 30,000 pounds per quality-adjusted life-year (QALY).…”

“…The cost of treatment with the new targeted therapies are in the range of UKP 3-6000 per 6 weeks, more than most patients can afford to pay. Decisions about their use in clinical practice would thus benefit from information about cost-effectiveness [11].…”

Cost-effectiveness evaluation of sunitinib as first-line targeted therapy for metastatic renal cell carcinoma in Spain

“…In the sourced trials of sunitinib, SFN and BEV/ IFN, patient cohorts were similar with regard to the proportion of patients with clear cell histology, prior nephrectomy, gender distribution and MSKCC risk groups. The In keeping with epidemiological data indicating that <1% of patients with mRCC survive for 10 years [18,35], the present model assumed a 10-year time horizon to represent a lifetime perspective [23]. Accordingly, PFS and OS data were extrapolated to 10 years using patientlevel data and parametric survival curves.…”

“…A National Institute for Health and Clinical Excellence (NICE) Health Technology Assessment estimate of the cost effectiveness of treatments for mRCC stated that sunitinib was likely to be considered cost effective above a WTP threshold of £75,000 per QALY gained compared with both BEV/IFN and IFN-. Subsequently, NICE recommended the use of sunitinib as fi rst-line treatment for patients with advanced mRCC with an Eastern Cooperative Oncology Group performance status of 0 or 1 and considered suitable for immunotherapy [16,18]. Similarly, in another cost-effectiveness analysis based on indirect comparisons using the Markov economic model adapted for the Swedish Health Service, sunitinib was seen as a cost-effective option for fi rst-line mRCC therapy compared with SFN, BEV/IFN and temsirolimus [40].…”

“…It may represent the reference standard of care for the fi rst-line treatment of mRCC [1,2,5,7,[15][16][17] and, based on robust clinical evidence, it meets the criteria for being a life-extending end-of-life treatment [16]. A systematic review demonstrated that, although the OS with sunitinib and BEV plus IFN- (BEV/ IFN) was prolonged, compared with IFN-, indirect comparison suggested that sunitinib was superior to BEV/IFN in terms of PFS [18,19].…”