title: Lifetime cost of everolimus vs axitinib in patients with advanced renal cell carcinoma who failed prior sunitinib therapy in the US.
abstract: OBJECTIVE
  Everolimus and axitinib are approved in the US to treat patients with advanced renal cell carcinoma (RCC) after failure on sunitinib or sorafenib, and one prior systemic therapy (e.g., sunitinib), respectively. Two indirect comparisons performed to evaluate progression-free survival in patients treated with everolimus vs axitinib suggested similar efficacy between the two treatments. Therefore, this analysis compares the lifetime costs of these two therapies among sunitinib-refractory advanced RCC patients from a US payer perspective.
  
  
  METHODS
  A Markov model was developed to simulate a cohort of sunitinib-refractory advanced RCC patients and estimate the cost of treating patients with everolimus vs axitinib. The following health states were included: stable disease without adverse events (AEs), stable disease with AEs, disease progression (PD), and death. The model included the following resources: active treatments, post-progression treatments, adverse events, physician and nurse visits, scans and tests, and palliative care. Resource utilization inputs were derived from a US claims database analysis. Additionally, a 3% annual discount rate was applied to costs, and the robustness of the model results was tested by conducting sensitivity analyses, including those on dosing scheme and post-progression treatment costs.
  
  
  RESULTS
  Base case results demonstrated that patients treated with everolimus cost an average of $12,985 (11%) less over their lifetimes than patients treated with axitinib. The primary difference in costs was related to active treatment, which was largely driven by axitinib's higher dose intensity. RESULTS remained consistent across sensitivity analyses for AE and PD treatment costs, as well as dose intensity and discount rates.
  
  
  CONCLUSIONS
  The results suggest that everolimus likely leads to lower lifetime costs than axitinib for sunitinib-refractory advanced RCC patients in the US.
authors.affiliation: LASER Analytica , New York, NY , USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Perrin
authors.forename: Steven
authors.initials: S
authors.lastname: Sherman
authors.forename: Sumanta
authors.initials: S
authors.lastname: Pal
authors.forename: Andrew
authors.initials: A
authors.lastname: Chua
authors.forename: Magdaliz
authors.initials: M
authors.lastname: Gorritz
authors.forename: Zhimei
authors.initials: Z
authors.lastname: Liu
authors.forename: Xufang
authors.initials: X
authors.lastname: Wang
authors.forename: Kenneth
authors.initials: K
authors.lastname: Culver
authors.forename: Roman
authors.initials: R
authors.lastname: Casciano
authors.forename: Louis P
authors.initials: LP
authors.lastname: Garrison
mesh_terms: D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use; D000077784:Axitinib; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000401:mortality; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D000068338:Everolimus / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D005102:Health Expenditures; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D007191:Indazoles / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D007211:Indoles / Q000627:therapeutic use; D008390:Markov Chains; D017059:Models, Econometric; D011758:Pyrroles / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D000077210:Sunitinib; D014481:United States
chemical_list: D000970:Antineoplastic Agents; D007093:Imidazoles; D007191:Indazoles; D007211:Indoles; D011758:Pyrroles; D000068338:Everolimus; D000077784:Axitinib; D000077210:Sunitinib
keywords: Axitinib; Costs analysis; Economic models; Everolimus; Renal cell carcinoma