Cost-effectiveness of sorafenib for second-line treatment of advanced renal cell carcinoma.
OBJECTIVE
To estimate the cost-effectiveness of sorafenib (Nexavar, Bayer, Leverkusen, Germany) versus best supportive care (BSC) for second-line treatment of advanced renal cell carcinoma from the perspective of the UK National Health Service.


METHODS
A decision analytic model was developed to estimate the cost-effectiveness of sorafenib. The clinical effectiveness of sorafenib versus BSC was taken from a recent randomized phase III trial. Utility values were taken from a phase II trial of sunitinib, using EQ-5D tariffs. Cost data were obtained from published literature and were based on current UK practice. The effect of parameter uncertainty on cost-effectiveness was explored through extensive one-way and probabilistic sensitivity analyses.


RESULTS
Compared to BSC, sorafenib treatment resulted in an incremental cost per quality-adjusted life year (QALY) gained of pound75,398, based on an estimated mean gain of 0.27 QALYs per patient, at a mean additional cost of pound20,063 (inflated to 2007/2008). The probability that sorafenib is cost-effective compared to BSC at a willingness to pay threshold of pound30,000 per QALY is 0.0%. In sensitivity analysis, estimates of cost per QALY were sensitive to changes in the clinical effectiveness parameters, and to health state utilities and drug costs.


CONCLUSIONS
Sorafenib has been shown to be clinically effective compared to BSC, offering additional health benefits; however, with a cost per QALY in excess of pound70,000, it may not be regarded as a cost-effective use of resources in some health-care settings.
Peninsula Medical School, University of Plymouth, Plymouth, UK. martin.hoyle@pms.ac.uk
Martin
M
Hoyle
Colin
C
Green
Jo
J
Thompson-Coon
Zulian
Z
Liu
Karen
K
Welch
Tiffany
T
Moxham
Ken
K
Stein
D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use*; D001557:Benzenesulfonates / Q000191:economics* / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000191:economics; D017024:Chemotherapy, Adjuvant / Q000191:economics; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D018450:Disease Progression; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000191:economics; D008390:Markov Chains; D015233:Models, Statistical; D009313:National Health Programs; D009536:Niacinamide / Q000031:analogs & derivatives; D010671:Phenylurea Compounds; D011725:Pyridines / Q000191:economics* / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D000077157:Sorafenib; D006113:United Kingdom
D000970:Antineoplastic Agents; D001557:Benzenesulfonates; D010671:Phenylurea Compounds; D011725:Pyridines; D009536:Niacinamide; D000077157:Sorafenib