Economic evaluation of sunitinib versus pazopanib and best supportive care for the treatment of metastatic renal cell carcinoma in Chile: cost-effectiveness analysis and a mixed treatment comparison

Expert Rev Pharmacoecon Outcomes Res. 2019 Oct;19(5):609-617. doi: 10.1080/14737167.2019.1580572. Epub 2019 Mar 7.

Abstract

Background: Sunitinib and Pazopanib are two metastatic renal cell carcinoma (MRCC) treatment alternatives, however the health system in Chile does not consider coverage for any. The cost-effectiveness versus relevant comparator was assessed to support evidence-based decision making. Methods: A four health states Markov model was built: first, second line treatments, BSC and death. Benefits were measured in QALYs, and efficacy estimates were obtained from an indirect treatment comparison. A 10-year time horizon and a 3% undifferentiated discount rate were considered. Deterministic and probabilistic sensitivity analyses were performed. Results: The costs of treating MRCC with Sunitinib were higher than Pazopanib and BSC. When comparing Sunitinib versus Pazopanib, the incremental benefit is small favoring Sunitinib (0.03 QALYs). The base case scenario shows an average ICER of PA versus BSC of US$62,327.11/QALY and of US$85,885/QALY for Sunitinib versus Pazopanib. The ICER was most sensitive to the OS relative to BSC, where evidence was associated to important bias. Conclusions: Sunitinib or Pazopanib can be considered cost-effective if a 3 GDP per-capita threshold is assumed. The decision between SU or PA is highly sensitive to the price of the drugs, rather than the outcomes. Therefore, the decision might be made based on cost-minimization exercise.

Keywords: Health technology assessment; cost-effectiveness; pazopanib; receptor tyrosine kinase inhibitors; renal cell carcinoma; sunitinib.

Publication types

  • Comparative Study

MeSH terms

  • Angiogenesis Inhibitors / administration & dosage
  • Angiogenesis Inhibitors / economics
  • Antineoplastic Agents / administration & dosage
  • Antineoplastic Agents / economics
  • Carcinoma, Renal Cell / drug therapy*
  • Carcinoma, Renal Cell / economics
  • Carcinoma, Renal Cell / pathology
  • Chile
  • Cost-Benefit Analysis
  • Decision Making
  • Drug Costs
  • Evidence-Based Medicine
  • Health Status
  • Humans
  • Indazoles
  • Kidney Neoplasms / drug therapy*
  • Kidney Neoplasms / economics
  • Kidney Neoplasms / pathology
  • Markov Chains
  • Models, Economic
  • Neoplasm Metastasis
  • Pyrimidines / administration & dosage*
  • Pyrimidines / economics
  • Quality-Adjusted Life Years
  • Sulfonamides / administration & dosage*
  • Sulfonamides / economics
  • Sunitinib / administration & dosage*
  • Sunitinib / economics

Substances

  • Angiogenesis Inhibitors
  • Antineoplastic Agents
  • Indazoles
  • Pyrimidines
  • Sulfonamides
  • pazopanib
  • Sunitinib