Cost–effectiveness of sorafenib compared to best supportive care in second line renal cell cancer from a payer perspective in Cyprus

Abstract

The objective of this study is to assess the cost effectiveness of sorafenib as a second line treatment of advanced renal cell carcinoma compared to standard best supportive care (BSC) in Cyprus. A probabilistic Decision analytic Markov Model was created to simulate disease progression and data from landmark trials were used. Actual local costs were set according to current guidelines in Cyprus. The incremental cost per quality adjusted life year of sorafenib versus BSC was €102,059. The probability of sorafenib to be cost effective at the threshold of €60,000 was 0%. Total costs were sensitive to the price of product, its effectiveness and to a lesser degree to the utility values. Sorafenib demonstrated superior clinical effectiveness compared to BSC, but it's not cost effective under current willingness to pay threshold. Its orphan status along with solidarity principle may justify reimbursement on an individual patient basis.

Keywords::

• cost utility
• cost-effectiveness
• decision modeling
• Markov Model
• second line renal cell carcinoma
• sorafenib
• EVPI

Acknowledgements

The authors are grateful to Gianluca Baio (Lecturer in Medical statistics, UCL) for his assistance in constructing and evaluating the WinBUGS and BCEA code used in this manuscript and to Nicky Welton (Senior Lecturer in HTA, Bristol University) for her input regarding the Expected Value of Perfect Information. We are also grateful to the Editor, Caroline Purslow and the three anonymous referees for their valuable comments in an earlier version of this paper, which enabled us to further improve it.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• There is clear need for more effective agents in metastatic renal cell cancer.

• Sorafenib is superior to best supportive care in second-line metastatic renal cell cancer.

• Treatment with sorafenib is significantly more expensive than BSC, and it is not considered cost-effective under current willingness to pay threshold. Cost of sorafenib dominates cost decomposition of total disease cost.

• Sorafenib is an orphan drug that allows health agencies to pay a premium for specific patients' cohorts. Solidarity principles provide that orphans drugs must be available under strict conditions.

• Introduction and launch of new agents are expected to enhance competition and reduce prices, facilitating access to more patients.

• New reimbursement approaches, such as risk sharing, may enable access to more patients by connecting outcomes to reimbursement.