title: Cost-effectiveness of pazopanib versus sunitinib for renal cancer in the United States.
abstract: BACKGROUND
  Current first-line treatments for metastatic renal cell carcinoma (mRCC) include the multityrosine kinase inhibitors pazopanib and sunitinib. Both agents had similar progression-free survival (PFS) and overall survival (OS) in the COMPARZ trial (Comparing the Efficacy, Safety and Tolerability of Pazopanib versus Sunitinib); however, the adverse event profiles of the 2 agents are different. In the PISCES trial (Patient Preference Study of Pazopanib versus Sunitinib in Advanced or Metastatic Kidney Cancer), patients and physicians preferred pazopanib primarily because it offered better health-related quality of life (HRQoL) and caused less fatigue.
  
  
  OBJECTIVE
  To compare the cost-effectiveness of pazopanib versus sunitinib from a U.S. health care system perspective in the first-line treatment of patients with mRCC.
  
  
  METHODS
  A partitioned-survival analysis model with 3 health states (preprogression, postprogression, and dead), data from 2 randomized controlled trials of pazopanib versus sunitinib (COMPARZ and PISCES), and secondary sources were used to calculate the incremental cost per quality-adjusted life-year (QALY) gained for pazopanib versus sunitinib. A time horizon of 37.5 months was used in the base case, consistent with the duration of follow-up used in the COMPARZ trial. The proportion of patients in each health state over time was based on Kaplan-Meier survival distributions for PFS and OS from the COMPARZ trial. Utility values were obtained from the PISCES trial. Costs were based on medical resource utilization data from the COMPARZ trial and unit costs from secondary sources. Probabilistic sensitivity analyses and deterministic sensitivity analyses were conducted.
  
  
  RESULTS
  In the base case, pazopanib was estimated to provide more QALYs at a lower cost compared with sunitinib (pazopanib dominant). In probabilistic sensitivity analyses, pazopanib was projected to be dominant in 69% of the simulations. The probability that pazopanib was more cost-effective than sunitinib was ≥ 90% for threshold values of cost-effectiveness between the range of $10,000-$160,000 per QALY gained. In deterministic sensitivity analyses, pazopanib was dominant in all scenarios examined.
  
  
  CONCLUSIONS
  Results of this study suggest that pazopanib is cost-effective compared with sunitinib as the first-line treatment of patients with mRCC in the United States.
authors.affiliation: olicy Analysis Inc., Four Davis Ct., Brookline, MA 02445. tdelea@pai2.com.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Delea
authors.forename: Jordan
authors.initials: J
authors.lastname: Amdahl
authors.forename: Jose
authors.initials: J
authors.lastname: Diaz
authors.forename: Hamid Reza
authors.initials: HR
authors.lastname: Nakhaipour
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Hackshaw
mesh_terms: D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000191:economics*; D003362:Cost-Benefit Analysis / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007191:Indazoles; D007211:Indoles / Q000191:economics* / Q000627:therapeutic use; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000191:economics*; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D011743:Pyrimidines / Q000191:economics* / Q000627:therapeutic use; D011758:Pyrroles / Q000191:economics* / Q000627:therapeutic use; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D013449:Sulfonamides / Q000191:economics* / Q000627:therapeutic use; D000077210:Sunitinib; D016019:Survival Analysis; D014481:United States
chemical_list: D007191:Indazoles; D007211:Indoles; D011743:Pyrimidines; D011758:Pyrroles; D013449:Sulfonamides; C516667:pazopanib; D000077210:Sunitinib