Economic evaluation of sunitinib versus pazopanib and best supportive care for the treatment of metastatic renal cell carcinoma in Chile: cost-effectiveness analysis and a mixed treatment comparison

ABSTRACT

Background: Sunitinib and Pazopanib are two metastatic renal cell carcinoma (MRCC) treatment alternatives, however the health system in Chile does not consider coverage for any. The cost-effectiveness versus relevant comparator was assessed to support evidence-based decision making.

Methods: A four health states Markov model was built: first, second line treatments, BSC and death. Benefits were measured in QALYs, and efficacy estimates were obtained from an indirect treatment comparison. A 10-year time horizon and a 3% undifferentiated discount rate were considered. Deterministic and probabilistic sensitivity analyses were performed.

Results: The costs of treating MRCC with Sunitinib were higher than Pazopanib and BSC. When comparing Sunitinib versus Pazopanib, the incremental benefit is small favoring Sunitinib (0.03 QALYs). The base case scenario shows an average ICER of PA versus BSC of US$62,327.11/QALY and of US$85,885/QALY for Sunitinib versus Pazopanib. The ICER was most sensitive to the OS relative to BSC, where evidence was associated to important bias.

Conclusions: Sunitinib or Pazopanib can be considered cost-effective if a 3 GDP per-capita threshold is assumed. The decision between SU or PA is highly sensitive to the price of the drugs, rather than the outcomes. Therefore, the decision might be made based on cost-minimization exercise.

KEYWORDS:

• Health technology assessment
• cost-effectiveness
• renal cell carcinoma
• sunitinib
• receptor tyrosine kinase inhibitors
• pazopanib

Author contributions

Study conception and design: Constanza Vargas, Manuel Espinoza

Acquisition of data: Carlos Balmaceda, Andres Giglio, Francisca Rodriguez, Ruben Rojas

Analysis and interpretation of data: Constanza Vargas, Manuel Espinoza, Carlos Balmaceda

Drafting of manuscript: Constanza Vargas, Manuel Espinoza

Critical revision: Constanza Vargas, Manuel Espinoza, Carlos Balmaceda, Francisca Rodríguez, Ruben Rojas

Final approval of the version to be published: Constanza Vargas, Manuel Espinoza, Carlos Balmaceda, Andres Giglio, Francisca Rodriguez, Ruben Rojas.

*All authors agree to be accountable for all aspects of the work.

Declaration of interest

C Vargas, M Espinoza and R Rojas disclose that as researchers they have conducted trainings and conferences on economic evaluations in health which have been financed by the pharmaceutical industry. As part of the academia, M Espinoza and R Rojas have also supported the Ministry of Health. The HTA unit, as part of the University, conducts studies financed by public and private sources including pharmaceutical companies (C Balmaceda, C Vargas, M Espinoza, R Rojas). F Rodriguez discloses that she has supported the pharmaceutical chamber in Chile and has previous experience working at the Ministry of Health in the elaboration of clinical guidelines. All authors have worked on several projects which were financed by the pharmaceutical industry, however, all of them have been conducted under strict clauses of independence.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was funded by Pfizer Chile. This study was conducted under strict clauses of independence. The sponsors did not contribute at all in the development of this research.