Cost-effectiveness of temsirolimus for first line treatment of advanced renal cell carcinoma.
OBJECTIVE
To estimate the cost-effectiveness of temsirolimus compared to interferon-alpha for first line treatment of patients with advanced, poor prognosis 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 temsirolimus. The clinical effectiveness of temsirolimus compared with interferon-alpha and the utility values (using EQ-5D tariffs) were taken from a recent phase III randomized clinical trial. Cost data were obtained from published literature and 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 interferon-alpha, temsirolimus treatment resulted in an incremental cost per QALY gained of pound94,632; based on an estimated mean gain of 0.24 quality-adjusted life years (QALYs) per patient, at a mean additional cost of pound22,331 (inflated to 2007/8). The cost per QALY for patient subgroups ranged from pound74,369 to pound154,752. The probability that temsirolimus is cost-effective compared to interferon-alpha at a willingness to pay threshold of pound30,000 per QALY for all patient groups is expected to be close to zero. The cost per QALY was sensitive to the clinical effectiveness parameters, health state utilities, drug costs and the cost of administration of temsirolimus.


CONCLUSIONS
Temsirolimus has been shown to be clinically effective compared to interferon-alpha offering additional health benefits, however, with a cost per QALY in excess of pound90,000, 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*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000191:economics; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006801:Humans; D007155:Immunologic Factors / Q000191:economics / Q000627:therapeutic use; D016898:Interferon-alpha / Q000191:economics / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000191:economics; D009313:National Health Programs; D019057:Quality-Adjusted Life Years; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D006113:United Kingdom
D000970:Antineoplastic Agents; D007155:Immunologic Factors; D016898:Interferon-alpha; C401859:temsirolimus; D020123:Sirolimus