title: Costs of managing adverse events in the treatment of first-line metastatic renal cell carcinoma: bevacizumab in combination with interferon-alpha2a compared with sunitinib.
abstract: BACKGROUND
  Bevacizumab plus interferon-alpha2a (IFN) prolongs progression-free survival to >10 months, which is comparable with sunitinib as first-line treatment of metastatic renal cell carcinoma (RCC). The two regimens have different tolerability profiles; therefore, costs for managing adverse events may be an important factor in selecting therapy.
  
  
  METHODS
  Costs of managing adverse events affecting patients with metastatic RCC eligible for treatment with bevacizumab plus IFN or sunitinib were evaluated using a linear decision analytical model. Management costs were calculated from the published incidence of adverse events and health-care costs for treating adverse events in the United Kingdom, Germany, France and Italy.
  
  
  RESULTS
  Adverse event management costs were higher for sunitinib than for bevacizumab plus IFN. The average cost per patient for the management of grade 3-4 adverse events was markedly lower with bevacizumab plus IFN compared with sunitinib in the United Kingdom (euro1475 vs euro804), Germany (euro1785 vs euro1367), France (euro2590 vs euro1618) and Italy (euro891 vs euro402). The main cost drivers were lymphopaenia, neutropaenia, thrombocytopaenia, leucopaenia and fatigue/asthaenia for sunitinib; and proteinuria, fatigue/asthaenia, bleeding, anaemia and gastrointestinal perforation for bevacizumab plus IFN.
  
  
  CONCLUSIONS
  The costs of managing adverse events are lower for bevacizumab plus IFN than for sunitinib. The potential for cost savings should be considered when selecting treatments for RCC.
authors.affiliation: Center of Operative Urology, Bremen 28277, Germany. gerald.mickisch@coub.de
authors.forename: G
authors.initials: G
authors.lastname: Mickisch
authors.forename: M
authors.initials: M
authors.lastname: Gore
authors.forename: B
authors.initials: B
authors.lastname: Escudier
authors.forename: G
authors.initials: G
authors.lastname: Procopio
authors.forename: S
authors.initials: S
authors.lastname: Walzer
authors.forename: M
authors.initials: M
authors.lastname: Nuijten
mesh_terms: D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D000068258:Bevacizumab; D002292:Carcinoma, Renal Cell / Q000188:drug therapy / Q000556:secondary*; D017326:Clinical Trials, Phase III as Topic / Q000191:economics; D064420:Drug-Related Side Effects and Adverse Reactions / Q000191:economics; D005602:France; D005767:Gastrointestinal Diseases / Q000139:chemically induced / Q000191:economics; D005858:Germany; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006402:Hematologic Diseases / Q000139:chemically induced / Q000191:economics; D017721:Hospital Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics; D006801:Humans; D006973:Hypertension / Q000139:chemically induced / Q000191:economics; D007211:Indoles / Q000009:adverse effects* / Q000627:therapeutic use; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage / Q000009:adverse effects*; D007558:Italy; D007680:Kidney Neoplasms / Q000188:drug therapy*; D047428:Protein Kinase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D011758:Pyrroles / Q000009:adverse effects* / Q000627:therapeutic use; D011994:Recombinant Proteins; D000077210:Sunitinib; D006113:United Kingdom; D020246:Venous Thrombosis / Q000139:chemically induced / Q000191:economics
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007211:Indoles; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D047428:Protein Kinase Inhibitors; D011758:Pyrroles; D011994:Recombinant Proteins; D000068258:Bevacizumab; D000077210:Sunitinib