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

• DOI: 10.1007/s12094-011-0748-0
• Publication Date: 2011-12-06T14:50:59Z
• Authors: Emiliano Calvo Aller; Pablo Maroto; Noémi Kreif; José Luis Gonzále...; Marta López-Brea; Daniel Castellano; Belén Martí; Silvia Díaz Cerezo
• Keywords: Niacinamide; Indoles; Pyridines; Cost-Benefit Analysis; Metastatic renal cell carcinoma; Angiogenesis Inhibitors; Antiviral Agents; Cost effectiveness; 03 medical and health sciences; 0302 clinical medicine; Sunitinib; Humans; Pyrroles; Carcinoma, Renal Cell; Protein Kinase Inhibitors; Clinical Trials as Topic; Phenylurea Compounds; Benzenesulfonates; Interferon-alpha; First-line; Sorafenib; Kidney Neoplasms; Markov Chains; 3. Good health; Models, Economic; Spain; Quality-Adjusted Life Years

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.