Cost-effectiveness evaluation of sunitinib as first-line targeted therapy for metastatic renal cell carcinoma in Spain
Por:
Aller, EC, Maroto, P, Kreif, N, Larriba, JLG, Lopez-Brea, M, Castellano, D, Marti, B, Cerezo, SD
Publicada:
1 dic 2011
Resumen:
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).
To assess the economic value of sunitinib as first-line therapy in mRCC within the Spanish healthcare system.
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-alpha (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.
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 a,not sign,124 and a,not sign23,218, respectively. Using a willingness-to-pay (WTP) threshold of a,not sign50,000/QALY, sunitinib achieved an incremental net benefit (INB) of a,not sign9,717 and a,not sign31,211 compared with SFN and BEV/IFN, respectively. At this WTP, the probability of sunitinib providing the highest INB was 75%.
Our analysis suggests that sunitinib is a cost-effective alternative to other targeted therapies as first-line mRCC therapy in the Spanish healthcare setting.
Filiaciones:
Aller, EC:
Hosp Univ Madrid Norte Sanchinarro, Ctr Integral Oncol Clara Campal, START Madrid, ES-28050 Madrid, Spain
Maroto, P:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Kreif, N:
United BioSource Corp, Hlth Care Analyt, London, England
Larriba, JLG:
Hosp Clini San Carlos, Madrid, Spain
Lopez-Brea, M:
Hosp Univ Marques Valdecilla, Santander, Cantabria, Spain
Castellano, D:
Hosp Univ 12 Octubre, Madrid, Spain
Marti, B:
Pfizer Espana, Outcomes Res, Madrid, Spain
Cerezo, SD:
Pfizer Espana, Outcomes Res, Madrid, Spain
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