First line treatment for metastatic renal cell carcinoma in Colombia : a cost-effectiveness analysis.

Abstract

Objective: To perform a local study based on an economic evaluation of first-line treatment of metastatic renal cell carcinoma in Colombia, since 2006-2007. Methods: We developed a Markov model using 6-week cycles to evaluate the cost-effectiveness of 4 interventions (IFN, sunitinib, bevacizumab + IFN, sorafenib) used as standard first-line treatment for mRCC in Colombia. The model used the thirdparty payer perspective and a 10-year time-line with all patients continuing with active treatment until progression, when it became acceptable to proceed to a second-line treatment or best supportive care (BSC). Results: Incremental analysis indicated a difference of US$21.796 in the average total cost of treatment when sunitinib was compared to IFN. Opposite, comparing sorafenib and bevacizumab + IFN to sunitinib demonstrated that the average total cost was less for sunitinib by US$25.857 and US$110.947 respectively. The ratios of incremental cost-effectiveness by life years gained (LYG) demonstrated sunitinib’s cost saving compared to sorafenib and the combination of bevacizumab + IFN, and an average by LYG of US$50.564,25 compared to IFN. Uncertainy is principally about sample size analized for Colombian population data. Conclusions: Sunitinib was the most cost-effective option as first-line treatment for mRCC patients in Colombia (2006- 2007), compared with the other available options. Current pharmacoeconomic data is important to improve knowledge and define the best sequence model to treat this disease in our country.