An Economic Evaluation of Everolimus As Second Line Treatment of Metastatic Renal Cell Carcinoma: A Malaysian Perspective

Abstract

Background: Everolimus as second line treatment of metastatic renal cell carcinoma are significantly effective but more expensive compared with best supportive care alone. Therefore, a cost-utility analysis was needed to inform the decision makers on the potential adoption of everolimus as second line treatment of metastatic renal cell carcinoma weighing by the affordability of the healthcare provider. Aim: To estimate the economic value of everolimus as second line treatment of metastatic renal cell carcinoma. Methods: A state transition model was developed using Microsoft Excel 2010 to simulate a hypothetical cohort of patient receiving everolimus or best supportive care over 5 years time horizon. A monthly cycle was used based on the dosing schedule of everolimus. Three health states were included in the model as progression free, disease progression and dead. A discount rate of 3% was applied as recommended in the Pharmacoeconomic Guidelines for Malaysia. The clinical and utility parameters were derived from the published literatures. Total costs were estimated using unit costs from various local sources and published cost data. Results: Based on 1000 Monte Carlo simulation the mean incremental discounted cost and QALY for everolimus were RM 32,605.28 and 0.35484 respectively, yielded a probabilistic incremental cost-effectiveness ratio (ICER) of RM 91,887. A minimal reduction in the value of ICER was observed when costs associated with adverse events were excluded and variation of price per tablet was explored. Conclusion: Everolimus may be considered a cost-effective strategy at the suggested value of cost-effectiveness threshold by World Health Organization (1-3 gross domestic product (GDP) per capita). However, if the suggested cost-effectiveness threshold for Malaysia is taken into consideration (≤ 1 GDP per capita), this treatment may not be a cost-effective strategy in Malaysia.