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

• Autores: Emiliano Calvo Aller, Pablo Maroto Rey, Noémi Kreif, José Luis González Larriba, Marta López-Brea, Daniel Castellano-Gauna, Belén Martí Sánchez, Silvia Díaz Cerezo
• Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 13, Nº. 12, 2011, págs. 869-877
• Idioma: inglés
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• Resumen

  • 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 first-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-? (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 �,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 cost-effective alternative to other targeted therapies as first-line mRCC therapy in the Spanish healthcare setting.