title: Cost-effectiveness of pazopanib compared with sunitinib in metastatic renal cell carcinoma in Canada.
abstract: BACKGROUND
  In Canada and elsewhere, pazopanib and sunitinib-tyrosine kinase inhibitors targeting the vascular endothelial growth factor receptors-are recommended as first-line treatment for patients with metastatic renal cell carcinoma (mrcc). A large randomized noninferiority trial of pazopanib versus sunitinib (comparz) demonstrated that the two drugs have similar efficacy; however, patients randomized to pazopanib experienced better health-related quality of life (hrqol) and nominally lower rates of non-study medical resource utilization.
  
  
  METHODS
  The cost-effectiveness of pazopanib compared with sunitinib for first-line treatment of mrcc from a Canadian health care system perspective was evaluated using a partitioned-survival model that incorporated data from comparz and other secondary sources. The time horizon of 5 years was based on the maximum duration of follow-up in the final analysis of overall survival from the comparz trial. Analyses were conducted first using list prices for pazopanib and sunitinib and then by assuming that the prices of sunitinib and pazopanib would be equivalent.
  
  
  RESULTS
  Based on list prices, expected costs were CA$10,293 less with pazopanib than with sunitinib. Pazopanib was estimated to yield 0.059 more quality-adjusted life-years (qalys). Pazopanib was therefore dominant (more qalys and lower costs) compared with sunitinib in the base case. In probabilistic sensitivity analyses, pazopanib was dominant in 79% of simulations and was cost-effective in 90%-100% of simulations at a threshold cost-effectiveness ratio of CA$100,000. Assuming equivalent pricing, pazopanib yielded CA$917 in savings in the base case, was dominant in 36% of probabilistic sensitivity analysis simulations, and was cost-effective in 89% of simulations at a threshold cost-effectiveness ratio of CA$100,000.
  
  
  CONCLUSIONS
  Compared with sunitinib, pazopanib is likely to be a cost-effective option for first-line treatment of mrcc from a Canadian health care perspective.
authors.affiliation: Policy Analysis Inc. ( pai ), Brookline, MA, U.S.A.;
authors.forename: J
authors.initials: J
authors.lastname: Amdahl
authors.affiliation: Bristol-Myers Squibb, Twickenham, Greater London, U.K.;
authors.forename: J
authors.initials: J
authors.lastname: Diaz
authors.affiliation: Novartis Pharmaceuticals Corporation, East Hanover, NJ, U.S.A.;
authors.forename: J
authors.initials: J
authors.lastname: Park
authors.affiliation: GlaxoSmith-Kline, Health Outcomes-Oncology, Mississauga, ON.
authors.forename: H R
authors.initials: HR
authors.lastname: Nakhaipour
authors.affiliation: Policy Analysis Inc. ( pai ), Brookline, MA, U.S.A.;
authors.forename: T E
authors.initials: TE
authors.lastname: Delea
keywords: Cost-effectiveness analyses; economic evaluations; partitioned-survival analyses; pazopanib; post-progression survival analyses; quality-adjusted life-years; sensitivity analyses; sunitinib