title: A cost-effectiveness analysis of sunitinib in patients with metastatic renal cell carcinoma intolerant to or experiencing disease progression on immunotherapy: perspective of the Spanish National Health System.
abstract: OBJECTIVE
  To investigate the cost-effectiveness of sunitinib (50 mg/day, schedule 4/2) vs. best supportive care (BSC) in patients with cytokine-refractory metastatic renal cell carcinoma (mRCC), from the perspective of the Spanish National Health Service.
  
  
  METHODS
  A Markov model compared the cost-effectiveness (taking into account drugs; medical visits; laboratory tests; X-rays; terminal care; adverse event management) of sunitinib and BSC across three disease states: no progression, survival with progression and death from mRCC or other causes.
  
  
  RESULTS
  The monthly incremental cost-effectiveness ratio (ICER) values for sunitinib treatment were €6073/progression-free survival month, €25,199/life years and €34,196/quality-adjusted life years (QALY) gained. In 95% of cases, the ICER/QALY values were below the accepted €45,000/QALY threshold. Efficacy and cost of sunitinib had the greatest impact on cost-effectiveness.
  
  
  CONCLUSIONS
  Sunitinib has a good cost-effectiveness profile in mRCC. The cost per life year and QALY gained is affordable according to current effectiveness thresholds in developed countries.
authors.affiliation: Oncology Department, Hospital 12 de Octubre, Madrid, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Paz-Ares
authors.forename: J G
authors.initials: JG
authors.lastname: del Muro
authors.forename: E
authors.initials: E
authors.lastname: Grande
authors.forename: S
authors.initials: S
authors.lastname: Díaz
mesh_terms: D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000191:economics / Q000556:secondary; D003362:Cost-Benefit Analysis; D016207:Cytokines / Q000627:therapeutic use*; D018450:Disease Progression; D018572:Disease-Free Survival; D016527:Drug Costs; D019008:Drug Resistance, Neoplasm; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007167:Immunotherapy; D007211:Indoles / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000473:pathology; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D010166:Palliative Care / Q000191:economics; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D011758:Pyrroles / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D013030:Spain; D000077210:Sunitinib
chemical_list: D020533:Angiogenesis Inhibitors; D016207:Cytokines; D007211:Indoles; D047428:Protein Kinase Inhibitors; D011758:Pyrroles; D000077210:Sunitinib