The development of new targeted therapies in kidney cancer has shaped disease management in the metastatic phase. Our study aims to conduct a cost-utility analysis of sunitinib versus pazopanib in first-line setting in Canada for metastatic renal cell carcinoma (mRCC) patients using real-world data.
A Markov model with Monte-Carlo microsimulations was developed to estimate the clinical and economic outcomes of patients treated in first-line with sunitinib versus pazopanib. Transition probabilities were estimated using observational data from a Canadian database where real-life clinical practice was captured. The costs of therapies, disease progression, and management of adverse events were included in the model in Canadian dollars ($Can). Utility and disutility values were included for each health state. Incremental cost-utility ratio (ICUR) and incremental cost-effectiveness ratios (ICER) were calculated for a time horizon of 5 years, from the Canadian Healthcare System perspective.
The cost difference was $36,303 and the difference in quality-adjusted life year (QALY) was 0.54 in favour of sunitinib with an ICUR of $67,227/QALY for sunitinib versus pazopanib. The major cost component (56%) is related to best supportive care (BSC) where patients tend to stay for a longer period of time compared to other states. The difference in life years gained (LYG) between sunitinib and pazopanib was 1.21 LYG (33.51 vs 19.03 months) and the ICER was $30,002/LYG. Sensitivity analysis demonstrated the robustness of the model with a high probability of sunitinib being a cost-effective option when compared to pazopanib.
When using real-world evidence, sunitinib is found to be a cost-effective treatment compared to pazopanib in mRCC patients in Canada.
Clinical drug investigation. 2018 Sep 28 [Epub ahead of print]
Sara Nazha, Simon Tanguay, Anil Kapoor, Michael Jewett, Christian Kollmannsberger, Lori Wood, G A Georg Bjarnason, Daniel Heng, Denis Soulières, Martin Neil Reaume, Naveen Basappa, Eric Lévesque, Alice Dragomir
McGill University Health Center, Montreal, QC, Canada., McMaster University, Hamilton, ON, Canada., Princess Margaret Cancer Center, Toronto, ON, Canada., University of British Columbia, Vancouver, BC, Canada., Dalhousie University and Queen Elizabeth II Health Sciences Center, Halifax, NS, Canada., Sunnybrooke Hospital, University of Toronto, Toronto, ON, Canada., Tom Baker Cancer Center, University of Calgary, Calgary, AB, Canada., Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, QC, Canada., University of Ottawa, Ottawa, ON, Canada., Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada., Centre Hospitalier Universitaire de Québec, Université de Laval, Quebec, QC, Canada., Health Economics and Outcomes Research, Research Institute of the McGill University Health Center, Surgery/Urology, McGill University, 5252 Maisonneuve West, Montreal, QC, H4A 3S5, Canada. .