Economic evaluation of sunitinib malate for the first-line treatment of metastatic renal cell carcinoma.
OBJECTIVE
To assess the cost effectiveness and cost utility of sunitinib malate as a first-line treatment in metastatic renal cell carcinoma (mRCC) compared with interferon-alfa (IFN-alpha) and interleukin-2 (IL-2) from a US societal perspective.


METHODS
A Markov model was developed to simulate disease progression and to determine progression-free survival, total life-years (LYs), and quality-adjusted life-years (QALYs) gained. Model parameters were derived from the pivotal trial of sunitinib, published literature, government sources, and clinical experts' opinions. The model included trial-based adverse events (AEs). Costs of drug treatment, routine follow-up, AEs, disease progression, and best supportive care (BSC) of terminally ill patients were included. Results were tested using probabilistic and deterministic sensitivity analyses.


RESULTS
Treatment with sunitinib is associated with a gain in progression-free years of 0.41 and 0.35 over IFN-alpha and IL-2. The estimated gains over IFN-alpha were 0.11 LYs and 0.14 QALYs, and over IL-2 were 0.24 LYs and 0.20 QALYs. Both IFN-alpha and sunitinib treatments dominate IL-2 treatment; the incremental cost-effectiveness ratio of sunitinib versus IFN-alpha was $18,611 per progression-free year gained and $67,215 per LY gained, and the cost-utility ratio is $52,593 per QALY gained (at a 5% discount rate). Sensitivity analyses found the results to be most sensitive to utility values during treatment, the cost of sunitinib, and the cost of BSC. Model results were robust to changes in other model variables.


CONCLUSIONS
These results suggest that sunitinib is a cost-effective alternative to IFN-alpha as a first-line treatment for mRCC.
Remák
Edit
E
Health Care Analytics, United BioSource Corp, 20 Bloomsbury Square, London WC1A 2NS, United Kingdom. edit.remak@unitedbiosource.com
Charbonneau
Claudie
C
Négrier
Sylvie
S
Kim
Sindy T
ST
Motzer
Robert J
RJ
D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000473:pathology; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D016527:Drug Costs; D006801:Humans; D007211:Indoles / Q000191:economics* / Q000627:therapeutic use*; D016898:Interferon-alpha / Q000191:economics / Q000627:therapeutic use; D007376:Interleukin-2 / Q000191:economics / Q000627:therapeutic use; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000473:pathology; D008329:Managed Care Programs / Q000191:economics; D008390:Markov Chains; D018803:Models, Economic; D009362:Neoplasm Metastasis; D011758:Pyrroles / Q000191:economics* / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D000077210:Sunitinib; D015996:Survival Rate
D000970:Antineoplastic Agents; D007211:Indoles; D016898:Interferon-alpha; D007376:Interleukin-2; D011758:Pyrroles; D000077210:Sunitinib