Real-world cost-effectiveness of targeted therapy in metastatic renal cell carcinoma in Sweden: a population-based retrospective analysis

Abstract

Objective

To explore cost-effectiveness of targeted therapies (TTs) in the treatment of metastatic renal cell carcinoma (mRCC) in a real-world context using a nationwide population-based approach.

Methods

Data on patients diagnosed with mRCC between 2002 and 2012 were extracted from Swedish national health data registers. To facilitate comparisons of patients diagnosed before and after TT introduction to the market, three cohorts were derived: pre-TT introduction (preTT), patients diagnosed 2002–2005; early TT introduction (TTi), patients diagnosed 2006–2008; and late TT introduction (TTii), which was limited to patients diagnosed 2009–2010 to ensure availability of total health care resource utilization (HCRU) data. Patients were followed until end of 2012. The value of TTs across cohorts was estimated using mean HCRU costs per life-year (LY) gained. Data on HCRU were obtained through national health registers for dispensed medication and inpatient and outpatient care, and the associated costs were estimated using the Lin method to account for censoring. LYs gained were defined as the difference in mean survival over the study period.

Results

The preTT, TTi, and TTii cohorts consisted of 1,366, 1,158, and 806 patients, respectively. Mean survival in years from mRCC diagnosis was 1.45 in the preTT cohort, 1.62 in the TTi cohort, and 1.83 in the TTii cohort. The respective mean total HCRU cost per patient over the study period was US$16,894, US$29,922, and US$30,037. The cost per LY gained per cohort was US$78,656 for TTi vs preTT, US$34,132 for TTii vs preTT, and US$523 for TTii vs TTi.

Conclusion

Given common willingness-to-pay per LY gained thresholds, this study in a real-world population suggests the use of TTs in the Swedish mRCC population is increasingly cost-effective over time.

Keywords:

• metastatic renal cell carcinoma
• targeted therapy
• cost-effectiveness
• Sweden

Acknowledgments

Editorial support was provided by Linda Cirella at Engage Pharma Group and was funded by Pfizer. This study was funded by Pfizer.

Disclosure

J Redig, J Dalén, and Ö Åkerborg, employees of ICON, were paid consultants to Pfizer for development of this manuscript. B Ljungberg reports personal fees from Ipsen, personal fees from Pfizer, personal fees from Novartis, personal fees from BMS, outside the submitted work. T Wahlgren, R Sandin, and M Jakobsson are employees of and own stock in Pfizer. M Lindskog, S Lundstam, B Ljungberg, and U Harmenberg were scientifically involved in this research. The authors report no other conflicts of interest in this work.