title: Economic evaluation of sunitinib malate in second-line treatment of metastatic renal cell carcinoma in Finland.
abstract: BACKGROUND
  Cytokine therapy is currently used as first-line treatment of metastatic renal cell carcinoma (mRCC). Until recently, treatments with proven efficacy after the failure of first-line cytokine therapy were not available. In recent clinical trials, sunitinib has been associated with good response rates in patients with mRCC.
  
  
  OBJECTIVE
  The aim of this study was to analyze the cost-effectiveness of sunitinib as second-line therapy for cytokine-refractory mRCC compared with current routine clinical practice in Finland (ie, best supportive care [BSC], including palliative biochemotherapy).
  
  
  METHODS
  A probabilistic decision-analytic model was developed to estimate the cost-effectiveness of sunitinib. Data were gathered from clinical trials, literature sources, and expert opinions, as well as from a local sample (n = 39) from 2 university hospitals in Finland. Clinical experts treating patients with mRCC in Finland provided the information on care practices of prescribing sunitinib. The analysis was conducted from the perspective of the health care payer in Finland.
  
  
  RESULTS
  According to estimated incremental cost-effectiveness ratios (ICERs), 1 progression-free month gained cost euro4802 (2005 Euros); 1 life-year gained cost euro30,831; and 1 quality-adjusted life-year (QALY) gained cost euro43,698, compared with BSC, in the treatment of mRCC. The expected mean cost in BSC was euro5543. When parameter uncertainty was considered, the probability of sunitinib being the more cost-effective choice of treatment was ~70% at the willingness-to-pay level of euro45,000/QALY gained.
  
  
  CONCLUSIONS
  Based on the results of this cost-effectiveness analysis, sunitinib is potentially cost-effective as a second-line treatment of mRCC compared with the treatment currently practiced in Finnish hospitals. The ICER (euro/QALY gained) obtained in the present study was less than the value considered suitable for novel oncology treatments.
authors.affiliation: Centre for Pharmaceutical Policy and Economics, Department of Social Pharmacy, University of Kuopio, Kuopio, Finland. Timo.Purmonen@uku.fi
authors.forename: Timo
authors.initials: T
authors.lastname: Purmonen
authors.forename: Janne A
authors.initials: JA
authors.lastname: Martikainen
authors.forename: Erkki J O
authors.initials: EJ
authors.lastname: Soini
authors.forename: Vesa
authors.initials: V
authors.lastname: Kataja
authors.forename: Riikka-Liisa
authors.initials: RL
authors.lastname: Vuorinen
authors.forename: Pirkko-Liisa
authors.initials: PL
authors.lastname: Kellokumpu-Lehtinen
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000191:economics / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000191:economics / Q000401:mortality / Q000556:secondary; D003362:Cost-Benefit Analysis; D016207:Cytokines / Q000627:therapeutic use; D003661:Decision Support Techniques; D018572:Disease-Free Survival; D016527:Drug Costs; D005260:Female; D005387:Finland / Q000453:epidemiology; D017048:Health Care Costs; D006801:Humans; D007211:Indoles / Q000191:economics / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000401:mortality / Q000473:pathology; D008297:Male; D008390:Markov Chains; D018803:Models, Economic; D010166:Palliative Care / Q000191:economics; D047428:Protein Kinase Inhibitors / Q000191:economics / Q000627:therapeutic use*; D011758:Pyrroles / Q000191:economics / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D000077210:Sunitinib; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D020533:Angiogenesis Inhibitors; D016207:Cytokines; D007211:Indoles; D047428:Protein Kinase Inhibitors; D011758:Pyrroles; D000077210:Sunitinib