title: Health care costs among renal cancer patients using pazopanib and sunitinib.
abstract: BACKGROUND
  Pazopanib was noninferior to sunitinib in progression-free survival in a phase III, open-label, randomized clinical trial comparing the efficacy and safety of the 2 drugs for treatment of patients with advanced renal cell carcinoma (RCC). A secondary analysis of this trial conducted on patient-reported health care resource utilization (HCRU) endpoints revealed significantly fewer monthly telephone consultations and emergency department visits among patients treated with pazopanib over the first 6 months of treatment.
  
  
  OBJECTIVE
  To (a) compare total costs of HCRU and adverse events (AEs) in patients with advanced RCC receiving first-line pazopanib or sunitinib from the phase III clinical trial and (b) perform a post hoc economic analysis that applied direct medical care and pharmacy unit costs, obtained from the Truven Health MarketScan Databases, to HCRU and AE rates.
  
  
  METHODS
  Total HCRU costs included components for provider contacts, diagnostics, hospitalizations, procedures, and study/nonstudy drugs. Patients were stratified by the presence or absence of an AE in order to estimate costs attributable to AEs. Costs were adjusted to 2013 U.S. dollars. The highest 1% of cost outliers were equally excluded from each group. Univariate (t-test and Kaplan-Meier sample average [KMSA]) and multivariate (using treatment group and region as covariates) analyses were performed.
  
  
  RESULTS
  A total of 906 patients (pazopanib, n = 454; sunitinib, n = 452) reported HCRU; higher rates were observed for sunitinib. In unadjusted cost analyses, the mean total costs for pazopanib-treated patients were 8.0% lower than those treated with sunitinib ($80,464 vs. $86,886; P = 0.20). The difference in KMSA-estimated costs was significantly higher for sunitinib versus pazopanib ($156,128 vs. $143,585; P = 0.003). Adjusted cost differences between arms consistently suggested higher costs for sunitinib. Among patients who experienced greater than or equal to 1 AE, costs were $8,118 higher for pazopanib-treated patients and $14,343 for sunitinib-treated patients.
  
  
  CONCLUSIONS
  The findings suggest that health care costs were lower among patients with advanced RCC treated first-line with pazopanib versus sunitinib.
authors.affiliation: University of Washington, Box 357630, Seattle, WA 98195. rhansen@uw.edu.
authors.forename: Ryan N
authors.initials: RN
authors.lastname: Hansen
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Hackshaw
authors.forename: Saurabh P
authors.initials: SP
authors.lastname: Nagar
authors.forename: Bhakti
authors.initials: B
authors.lastname: Arondekar
authors.forename: Keith C
authors.initials: KC
authors.lastname: Deen
authors.forename: Sean D
authors.initials: SD
authors.lastname: Sullivan
authors.forename: Scott D
authors.initials: SD
authors.lastname: Ramsey
mesh_terms: D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D007191:Indazoles; D007211:Indoles / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000191:economics*; D008297:Male; D008875:Middle Aged; D011743:Pyrimidines / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D011758:Pyrroles / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D013449:Sulfonamides / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D000077210:Sunitinib; D014481:United States
chemical_list: D007191:Indazoles; D007211:Indoles; D011743:Pyrimidines; D011758:Pyrroles; D013449:Sulfonamides; C516667:pazopanib; D000077210:Sunitinib