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Economic Evaluation of Sunitinib Malate for the First-Line Treatment of Metastatic Renal Cell Carcinoma

Edit Remák, Claudie Charbonneau, Sylvie Négrier, Sindy T. Kim, Robert J. Motzer

From the Health Care Analytics, United Biosource Corp, London, United Kingdom; Centre Léon Bérard, Lyon, France; Pfizer Global Research and Development; Memorial Sloan-Kettering Cancer Center, New York, NY; and Pfizer Global Research and Development, La Jolla, CA

Corresponding author: Edit Remák, MD, Health Care Analytics, United BioSource Corp, 20 Bloomsbury Square, London WC1A 2NS, United Kingdom; e-mail: edit.remak{at}unitedbiosource.com

Purpose To assess the cost effectiveness and cost utility of sunitinib malate as a first-line treatment in metastatic renal cell carcinoma (mRCC) compared with interferon-alfa (IFN-) and interleukin-2 (IL-2) from a US societal perspective.

Methods A Markov model was developed to simulate disease progression and to determine progression-free survival, total life-years (LYs), and quality-adjusted life-years (QALYs) gained. Model parameters were derived from the pivotal trial of sunitinib, published literature, government sources, and clinical experts’ opinions. The model included trial-based adverse events (AEs). Costs of drug treatment, routine follow-up, AEs, disease progression, and best supportive care (BSC) of terminally ill patients were included. Results were tested using probabilistic and deterministic sensitivity analyses.

Results Treatment with sunitinib is associated with a gain in progression-free years of 0.41 and 0.35 over IFN- and IL-2. The estimated gains over IFN- were 0.11 LYs and 0.14 QALYs, and over IL-2 were 0.24 LYs and 0.20 QALYs. Both IFN- and sunitinib treatments dominate IL-2 treatment; the incremental cost-effectiveness ratio of sunitinib versus IFN- was $18,611 per progression-free year gained and $67,215 per LY gained, and the cost-utility ratio is $52,593 per QALY gained (at a 5% discount rate). Sensitivity analyses found the results to be most sensitive to utility values during treatment, the cost of sunitinib, and the cost of BSC. Model results were robust to changes in other model variables.

Conclusion These results suggest that sunitinib is a cost-effective alternative to IFN- as a first-line treatment for mRCC.

Supported by Pfizer Inc.

Presented in part at the 43rd Annual Meeting of the American Society of Clinical Oncology, Chicago, IL, June 1-5, 2007; the 14th European Cancer Conference, Barcelona, Spain, September 23-27, 2007; and the European Association of Hospital Pharmacists, Berlin, Germany, March 21-23, 2007.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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Related Correspondence

• Cost Effectiveness of Sunitinib
  Sabrina Trippoli and Andrea Messori
  JCO 2008 26: 5829 [Full Text]

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				S. Trippoli and A. Messori Cost Effectiveness of Sunitinib J. Clin. Oncol., December 10, 2008; 26(35): 5829 - 5829. [Full Text] [PDF]

				E. Remak In Reply J. Clin. Oncol., December 10, 2008; 26(35): 5829 - 5830. [Full Text] [PDF]