title: Cost-effectiveness evaluation of sunitinib as first-line targeted therapy for metastatic renal cell carcinoma in Spain.
abstract: INTRODUCTION Sunitinib, an oral, multitargeted receptor tyrosine kinase inhibitor, delays disease progression, with a median overall survival (OS) of more than 2 years, improves quality of life and is becoming the first-line standard of care for metastatic renal carcinoma (mRCC). PURPOSE To assess the economic value of sunitinib as fi rst-line therapy in mRCC within the Spanish healthcare system. METHODS An adapted Markov model with a 10-year time horizon was used to analyse the cost effectiveness of sunitinib vs. sorafenib (SFN) and bevacizumab/interferon-α (BEV/IFN) as first-line mRCC therapy from the Spanish third-party payer perspective. Progression-free survival (PFS) and OS data from sunitinib, SFN and BEV/IFN pivotal trials were extrapolated to project survival and costs in 6-week cycles. Results, in progression-free life-years (PFLY), life years (LY) and quality-adjusted life-years (QALY) gained, expressed as incremental cost-effectiveness ratios (ICER) with costs and benefits discounted annually at 3%, were obtained using deterministic and probabilistic analyses. RESULTS Sunitinib was more effective and less costly than both SFN (gains of 0.52 PFLY, 0.16 LY, 0.17 QALY) and BEV/IFN (gains of 0.19 PFLY, 0.23 LY, 0.16 QALY) with average cost savings/patients of €1,124 and €23,218, respectively. Using a willingness-to-pay (WTP) threshold of €50,000/QALY, sunitinib achieved an incremental net benefit (INB) of €9,717 and €31,211 compared with SFN and BEV/IFN, respectively. At this WTP, the probability of sunitinib providing the highest INB was 75%. CONCLUSION Our analysis suggests that sunitinib is a costeffective alternative to other targeted therapies as first-line mRCC therapy in the Spanish healthcare setting.
authors: START Madrid, Centro Integral Oncológico Clara Campal, Hospital Universitario Madrid Norte Sanchinarro, Spain. emilianocalvo@hospitaldemadrid.com
authors: E
authors: E
authors: Calvo Aller
authors: P
authors: P
authors: Maroto
authors: N
authors: N
authors: Kreif
authors: J L
authors: JL
authors: González Larriba
authors: M
authors: M
authors: López-Brea
authors: D
authors: D
authors: Castellano
authors: B
authors: B
authors: Martí
authors: S
authors: S
authors: Díaz Cerezo
mesh_terms: D020533:Angiogenesis Inhibitors / Q000191:economics* / Q000627:therapeutic use; D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use; D001557:Benzenesulfonates / Q000191:economics / Q000627:therapeutic use; D002292:Carcinoma, Renal Cell / Q000188:drug therapy / Q000191:economics* / Q000556:secondary; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D006801:Humans; D007211:Indoles / Q000191:economics* / Q000627:therapeutic use; D016898:Interferon-alpha / Q000191:economics / Q000627:therapeutic use; D007680:Kidney Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000473:pathology; D008390:Markov Chains; D018803:Models, Economic; D009536:Niacinamide / Q000031:analogs & derivatives; D010671:Phenylurea Compounds; D047428:Protein Kinase Inhibitors / Q000191:economics / Q000627:therapeutic use; D011725:Pyridines / Q000191:economics / Q000627:therapeutic use; D011758:Pyrroles / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D000077157:Sorafenib; D000077210:Sunitinib
chemical_list: D020533:Angiogenesis Inhibitors; D000998:Antiviral Agents; D001557:Benzenesulfonates; D007211:Indoles; D016898:Interferon-alpha; D010671:Phenylurea Compounds; D047428:Protein Kinase Inhibitors; D011725:Pyridines; D011758:Pyrroles; D009536:Niacinamide; D000077157:Sorafenib; D000077210:Sunitinib