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

Abstract

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]

Evaluación económica de los tratamientos de primera línea en pacientes con carcinoma de células renales metastásico en Colombia

“…Estos resultados son consistentes con varias evaluaciones económicas que incorporaron las mismas alternativas de tratamiento y un abordaje similar con respecto al modelo matemático y unidad de resultado (AVAC), en esa tendencia se encuentran: Rusia (Yagudina, Kulikov, & Novikov, 2012), China (J. Wu, Zhang, & Dong, 2011), Rumania (Berghea et al, 2013), España (S. Diaz et al, 2008), Brasil (Teich, Hashizume, Marinho, Charbonneau, & Naves, 2010), México (Tenorio et al, 2009), Ecuador (Torres Toala, Albuja Riofrio, Mould, & Estévez, 2013) y Colombia (Godoy et al, 2009). (Mihajlovic & Postma, 2014) utilizaron un modelo de Markov para evaluar la costo-efectividad de sunitinib, pazopanib, bevacizumab y temsirolimus.…”