Lifetime cost of everolimus vs axitinib in patients with advanced renal cell carcinoma who failed prior sunitinib therapy in the US

Abstract

Objective:

Everolimus and axitinib are approved in the US to treat patients with advanced renal cell carcinoma (RCC) after failure on sunitinib or sorafenib, and one prior systemic therapy (e.g., sunitinib), respectively. Two indirect comparisons performed to evaluate progression-free survival in patients treated with everolimus vs axitinib suggested similar efficacy between the two treatments. Therefore, this analysis compares the lifetime costs of these two therapies among sunitinib-refractory advanced RCC patients from a US payer perspective.

Research design and methods:

A Markov model was developed to simulate a cohort of sunitinib-refractory advanced RCC patients and estimate the cost of treating patients with everolimus vs axitinib. The following health states were included: stable disease without adverse events (AEs), stable disease with AEs, disease progression (PD), and death. The model included the following resources: active treatments, post-progression treatments, adverse events, physician and nurse visits, scans and tests, and palliative care. Resource utilization inputs were derived from a US claims database analysis. Additionally, a 3% annual discount rate was applied to costs, and the robustness of the model results was tested by conducting sensitivity analyses, including those on dosing scheme and post-progression treatment costs.

Results:

Base case results demonstrated that patients treated with everolimus cost an average of $12,985 (11%) less over their lifetimes than patients treated with axitinib. The primary difference in costs was related to active treatment, which was largely driven by axitinib’s higher dose intensity. Results remained consistent across sensitivity analyses for AE and PD treatment costs, as well as dose intensity and discount rates.

Conclusion:

The results suggest that everolimus likely leads to lower lifetime costs than axitinib for sunitinib-refractory advanced RCC patients in the US.

Keywords::

• Renal cell carcinoma
• Everolimus
• Axitinib
• Costs analysis
• Economic models

Transparency

Declaration of funding

Novartis Pharmaceuticals Corporation provided funding for this study. Novartis employees made clinical trial data available for analysis, and offered analytical suggestions. The sponsored research did not put limits on freedom to publish or the content of publication.

Declaration of financial/other relationships

RC, SS, AP, AC, & MG are employees of LASER Analytica, a consultancy that received compensation for the overall economic study design, the analysis, and preparation of this manuscript. ZL, XW, & KC are employees of and own stock in Novartis Pharmaceuticals Corporation. They also contributed to the analysis and manuscript preparation. SP's potential conflicts of interest include serving on advisory boards for Novartis and Aveo, performing corporate-sponsored research for GSK, and receiving honoraria from Pfizer, Novartis, Astellas and Medivation. LPG has served on an advisory board for Novartis and received compensation for his contributions to the study design, data analysis and preparation of the manuscript. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Previous presentations: This study was presented in part (Figure 1 and Tables 2, 4, and 6) at the Kidney Cancer Association, 12th International Kidney Cancer Symposium; October 25–26, 2013, Chicago, IL. The poster was titled, ‘The Lifetime Cost of Everolimus vs Axitinib in Metastatic Renal Cell Carcinoma Patients who have Failed Prior Sunitinib Therapy in the US’.