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Sunitinib appears to be cost-effective option for metastatic renal cell carcinoma, model shows

Friday, August 22 2008 | Comments

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What's This? From the U.S. societal perspective, sunitinib malate appears to be a cost effective alternative to interferon-alpha as a first-line treatment for metastatic renal cell carcinoma (mRCC), and both strategies dominate interleukin-2, according to a recently published analysis.

To determine the long-term (10 years) financial implications of using sunitinib as compared with interferon-alpha or interleukin-2 in this setting, the researchers created a Markov model to simulate disease-progression, total life-years (LYs) and quality-adjusted life years (QALYs). The model included a hypothetical cohort of 1,000 patients with mRCC receiving first-line treatment with sunitinib compared with interferon-alpha or interleukin-2. A cost effectiveness analysis and a cost-utility analysis were conducted using interferon-alpha as the base to which the other two therapies were compared.

Results show that patients treated with sunitinib had 0.92 progression-free years versus 0.51 years and 0.57 years for those treated with interferon-alpha and interleukin-2, respectively.  Sunitinib treatment was associated with an estimated gain of 0.11 LYs over interferon-alpha, and an estimated gain of 0.24 LYs over interleukin-2. Sunitinib treatment was also associated with an estimated gain of 0.14 QALYs over interferon-alpha and an estimated gain of 0.20 QALYs over interleukin-2.

Interleukin-2 was found to be less effective and more costly than both sunitinib or interferon-alpha.

Versus interferon-alpha, the incremental cost per progression-free year gained for sunitinib reached $18,611; the incremental cost estimate for survival reached $67,215 per LY gained, while the cost utility ratio reached  $52,593 per QALY gained. Probabilistic analyses indicate that sunitinib was the optimal treatment above a $55,000/QALY threshold. If the time period is reduced from 10 years to 1 year, the cost utility ratio increases to $120,304/QALY, but if 2-year analysis is used, the ratio raises to just $67,507/QALY.

"These data suggest that sunitinib is a cost-effective alternative to interferon-alpha as first-line treatment for mRCC, with cost effectiveness ratios within the established $50,000 to $100,000 per LY or QALY threshold that society is willing to pay for benefits," the authors concluded. (Remak E, et al. J Clin Oncol 2008;26:3995-4000.)

Pfizer Inc. provided funding for the study.

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