title: Economic evaluation of first-line treatments for metastatic renal cell carcinoma: a cost-effectiveness analysis in a health resource-limited setting.
abstract: BACKGROUND
  To estimate, from the perspective of the Chinese healthcare system, the economic outcomes of five different first-line strategies among patients with metastatic renal cell carcinoma (mRCC).
  
  
  RESULTS
  A decision-analytic model was developed to simulate the lifetime disease course associated with renal cell carcinoma. The health and economic outcomes of five first-line strategies (interferon-alfa, interleukin-2, interleukin-2 plus interferon-alfa, sunitinib and bevacizumab plus interferon-alfa) were estimated and assessed by indirect comparison. The clinical and utility data were taken from published studies. The cost data were estimated from local charge data and current Chinese practices. Sensitivity analyses were used to explore the impact of uncertainty regarding the results. The impact of the sunitinib patient assistant program (SPAP) was evaluated via scenario analysis. The base-case analysis showed that the sunitinib strategy yielded the maximum health benefits: 2.71 life years and 1.40 quality-adjusted life-years (QALY). The marginal cost-effectiveness (cost per additional QALY) gained via the sunitinib strategy compared with the conventional strategy was $220,384 (without SPAP, interleukin-2 plus interferon-alfa and bevacizumab plus interferon-alfa were dominated) and $16,993 (with SPAP, interferon-alfa, interleukin-2 plus interferon-alfa and bevacizumab plus interferon-alfa were dominated). In general, the results were sensitive to the hazard ratio of progression-free survival. The probabilistic sensitivity analysis demonstrated that the sunitinib strategy with SPAP was the most cost-effective approach when the willingness-to-pay threshold was over $16,000.
  
  
  CONCLUSIONS
  Our analysis suggests that traditional cytokine therapy is the cost-effective option in the Chinese healthcare setting. In some relatively developed regions, sunitinib with SPAP may be a favorable cost-effective alternative for mRCC.
authors.affiliation: Clinical Outcomes and Economics Group, Department of pharmacy, Renji Hospital, affiliated with the School of Medicine, Shanghai Jiaotong University, Shanghai, People's Republic of China.
authors.forename: Bin
authors.initials: B
authors.lastname: Wu
authors.forename: Baijun
authors.initials: B
authors.lastname: Dong
authors.forename: Yuejuan
authors.initials: Y
authors.lastname: Xu
authors.forename: Qiang
authors.initials: Q
authors.lastname: Zhang
authors.forename: Jinfang
authors.initials: J
authors.lastname: Shen
authors.forename: Huafeng
authors.initials: H
authors.lastname: Chen
authors.forename: Wei
authors.initials: W
authors.lastname: Xue
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000191:economics* / Q000556:secondary; D002681:China; D003362:Cost-Benefit Analysis; D006295:Health Resources / Q000600:supply & distribution; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000473:pathology; D018803:Models, Economic