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Cost-effectiveness evaluation of sunitinib as first-line targeted therapy for metastatic renal cell carcinoma in Spain

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Abstract

Introduction

Sunitinib, an oral, multitargeted receptor tyrosine kinase inhibitor, delays disease progression, with a median overall survival (OS) of more than 2 years, improves quality of life and is becoming the first-line standard of care for metastatic renal carcinoma (mRCC).

Purpose

To assess the economic value of sunitinib as first-line therapy in mRCC within the Spanish healthcare system.

Methods

An adapted Markov model with a 10-year time horizon was used to analyse the cost effectiveness of sunitinib vs. sorafenib (SFN) and bevacizumab/interferon-α (BEV/IFN) as first-line mRCC therapy from the Spanish third-party payer perspective. Progression-free survival (PFS) and OS data from sunitinib, SFN and BEV/IFN pivotal trials were extrapolated to project survival and costs in 6-week cycles. Results, in progression-free life-years (PFLY), life years (LY) and quality-adjusted life-years (QALY) gained, expressed as incremental cost-effectiveness ratios (ICER) with costs and benefits discounted annually at 3%, were obtained using deterministic and probabilistic analyses.

Results

Sunitinib was more effective and less costly than both SFN (gains of 0.52 PFLY, 0.16 LY, 0.17 QALY) and BEV/IFN (gains of 0.19 PFLY, 0.23 LY, 0.16 QALY) with average cost savings/patients of €,124 and €23,218, respectively. Using a willingness-to-pay (WTP) threshold of €50,000/QALY, sunitinib achieved an incremental net benefit (INB) of €9,717 and €31,211 compared with SFN and BEV/IFN, respectively. At this WTP, the probability of sunitinib providing the highest INB was 75%.

Conclusion

Our analysis suggests that sunitinib is a cost-effective alternative to other targeted therapies as first-line mRCC therapy in the Spanish healthcare setting.

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Authors and Affiliations

  1. START Madrid, Centro Integral Oncológico Clara Campal, Hospital Universitario Madrid Norte Sanchinarro, C/Oña, 10, ES-28050, Madrid, Spain

    Emiliano Calvo Aller

  2. Hospital de Santa Creu y Sant Pau, Barcelona, Spain

    Pablo Maroto

  3. Health Care Analytics, United BioSource Corporation, London, UK

    Noémi Kreif

  4. Hospital Clínico San Carlos, Madrid, Spain

    José Luis González Larriba

  5. Hospital Universitario Marqués de Valdecilla Santander, Cantabria, Spain

    Marta López-Brea

  6. Hospital Universitario 12 de Octubre, Madrid, Spain

    Daniel Castellano

  7. Outcomes Research, Pfizer España, Madrid, Spain

    Belén Martí & Silvia Díaz Cerezo

Authors
  1. Emiliano Calvo Aller
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  2. Pablo Maroto
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  3. Noémi Kreif
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  4. José Luis González Larriba
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  5. Marta López-Brea
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  6. Daniel Castellano
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  7. Belén Martí
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  8. Silvia Díaz Cerezo
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Corresponding author

Correspondence to Emiliano Calvo Aller.

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At present these authors are not working at Pfizer Spain.

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Calvo Aller, E., Maroto, P., Kreif, N. et al. Cost-effectiveness evaluation of sunitinib as first-line targeted therapy for metastatic renal cell carcinoma in Spain. Clin Transl Oncol 13, 869–877 (2011). https://doi.org/10.1007/s12094-011-0748-0

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  • DOI: https://doi.org/10.1007/s12094-011-0748-0

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