The NCCN Kidney Cancer Panel lists pazopanib and sunitinib as category 1 options for first-line treatment for stage IV renal cell carcinoma (RCC) patient. The aim of this study was to evaluate the cost-effectiveness of pazopanib vs sunitinib as first-line treatment of metastatic RCC (mRCC) from a Greek third-party payer's perspective.
A 3-state partitioned survival model was used. Estimates of progression free survival (PFS) and overall survival (OS) were from the COMPARZ trial. Utility values were based on adverse events in COMPARZ and EQ-5D data from the VEG105192 trial. Cost inputs included drug acquisition and other treatment related costs including physician visits and lab and radiology tests. Resource use data were collected by DELPHI method from an expert panel of clinicians from private and public hospitals in Greece. A 5-year time horizon was used consistent with the maximum duration of follow-up in the final analysis of OS in COMPARZ. The incremental cost-effectiveness ratio (ICER) was calculated. A threshold of €35,000 per QALY gained was used, per WHO Guidelines. Deterministic and probabilistic sensitivity analyses (DSA and PSA) were conducted.
In the base case, pazopanib was less costly and more effective (“dominant”) compared with sunitinib, with €3,676 lower lifetime costs per patient and 0.058 greater discounted QALYs (€25,464 vs €29,140 and 1.617 vs 1.558). DSA and PSA suggest these results are robust. In DSA, pazopanib was dominant for different assumptions regarding PFS and utilities (Table). In 66% of PSA simulations, pazopanib was projected to yield more QALYs and lower costs vs sunitinb. The probability that pazopanib is cost-effective vs sunitinib was estimated to be 90% given the ICER threshold.
|Scenario||Incremental Costs||Incremental QALYs||ICER|
|Base case (IRC PFS)||-€3,676||0.058||Dominant|
Pazopanib is likely to be dominant compared with sunitinib as first-line treatment of mRCC in the Greek healthcare setting.
Clinical trial identification
Legal entity responsible for the study
Dr. Georgia Kourlaba
A. Solakidi, G. Kourlaba: EVROSTON LP received funding from Novartis Hellas for this study M. Chatzikou: Novartis employee. However, the study sponsor had no influence on the study design, data collection or writing of the abstract. C. Michailidi: Novartis employee. However, the study sponsor had no influence on the study design, data collection or writing of the abstract. All other authors have declared no conflicts of interest.