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

Abstract

INTRODUCTION Sunitinib, an oral, multitargeted receptor tyrosine kinase inhibitor, delays disease progression, with a median overall survival (OS) of more than 2 years, improves quality of life and is becoming the first-line standard of care for metastatic renal carcinoma (mRCC). PURPOSE To assess the economic value of sunitinib as fi rst-line therapy in mRCC within the Spanish healthcare system. METHODS An adapted Markov model with a 10-year time horizon was used to analyse the cost effectiveness of sunitinib vs. sorafenib (SFN) and bevacizumab/interferon-α (BEV/IFN) as first-line mRCC therapy from the Spanish third-party payer perspective. Progression-free survival (PFS) and OS data from sunitinib, SFN and BEV/IFN pivotal trials were extrapolated to project survival and costs in 6-week cycles. Results, in progression-free life-years (PFLY), life years (LY) and quality-adjusted life-years (QALY) gained, expressed as incremental cost-effectiveness ratios (ICER) with costs and benefits discounted annually at 3%, were obtained using deterministic and probabilistic analyses. RESULTS Sunitinib was more effective and less costly than both SFN (gains of 0.52 PFLY, 0.16 LY, 0.17 QALY) and BEV/IFN (gains of 0.19 PFLY, 0.23 LY, 0.16 QALY) with average cost savings/patients of €1,124 and €23,218, respectively. Using a willingness-to-pay (WTP) threshold of €50,000/QALY, sunitinib achieved an incremental net benefit (INB) of €9,717 and €31,211 compared with SFN and BEV/IFN, respectively. At this WTP, the probability of sunitinib providing the highest INB was 75%. CONCLUSION Our analysis suggests that sunitinib is a costeffective alternative to other targeted therapies as first-line mRCC therapy in the Spanish healthcare setting.

Can the Leibovich score for clear cell renal cell carcinoma (ccRCC) be accurately reported by a general pathologist?

“…The present data indicate that it is important for RN pathology to be reviewed by a urological pathologist, as the prognostication of a patient accurately into the intermediate‐ and high‐risk LS prognostic group makes patients eligible for recruitment in clinical trials offering adjuvant treatment. Conversely, patients in whom the prognostic group is changed from intermediate‐ and high‐ to low‐risk not only require a less intense follow‐up schedule but more importantly do not require recruitment into clinical trials that recommend adjuvant treatments, which itself has toxicity related side‐effects and cost‐effectiveness issues . The present study has led to a change of practice at our center, where all nephrectomy specimens are reviewed by uro‐pathologist before a final LS is allocated.…”

“…In patients who are determined to be at high risk of developing recurrence there continues to be a cohort of patients who have significant side‐effects with adjuvant treatment and are unable to complete the recommended course of treatment . In the current economic climate there are further studies that evaluate the indications and cost effectiveness of commencing tyrosine kinase inhibitors in patients with mRCC .…”

Sunitinib: Ten Years of Successful Clinical Use and Study in Advanced Renal Cell Carcinoma

“…The results indicated that sunitinib was cost effective compared with IFN as first‐line mRCC therapy. Similarly, an analysis of the economic value of sunitinib as first‐line mRCC therapy in the Spanish health care system found that sunitinib was a cost‐effective alternative to other targeted therapies, specifically sorafenib and bevacizumab plus IFN .…”