Abstract
In Canada and elsewhere, pazopanib and sunitinib-tyrosine kinase inhibitors targeting the vascular endothelial growth factor receptors-are recommended as first-line treatment for patients with metastatic renal cell carcinoma (mrcc). A large randomized noninferiority trial of pazopanib versus sunitinib (comparz) demonstrated that the two drugs have similar efficacy; however, patients randomized to pazopanib experienced better health-related quality of life (hrqol) and nominally lower rates of non-study medical resource utilization. The cost-effectiveness of pazopanib compared with sunitinib for first-line treatment of mrcc from a Canadian health care system perspective was evaluated using a partitioned-survival model that incorporated data from comparz and other secondary sources. The time horizon of 5 years was based on the maximum duration of follow-up in the final analysis of overall survival from the comparz trial. Analyses were conducted first using list prices for pazopanib and sunitinib and then by assuming that the prices of sunitinib and pazopanib would be equivalent. Based on list prices, expected costs were CA$10,293 less with pazopanib than with sunitinib. Pazopanib was estimated to yield 0.059 more quality-adjusted life-years (qalys). Pazopanib was therefore dominant (more qalys and lower costs) compared with sunitinib in the base case. In probabilistic sensitivity analyses, pazopanib was dominant in 79% of simulations and was cost-effective in 90%-100% of simulations at a threshold cost-effectiveness ratio of CA$100,000. Assuming equivalent pricing, pazopanib yielded CA$917 in savings in the base case, was dominant in 36% of probabilistic sensitivity analysis simulations, and was cost-effective in 89% of simulations at a threshold cost-effectiveness ratio of CA$100,000. Compared with sunitinib, pazopanib is likely to be a cost-effective option for first-line treatment of mrcc from a Canadian health care perspective.
Highlights
Renal cell carcinomas arise in the renal epithelium and account for approximately 85% of all kidney cancers[1]
Analysis Based on List Prices of Pazopanib and Sunitinib
At threshold cost-effectiveness values of Cost per weeks of treatment (CA$)100,000, CA$150,000, and CA$200,000 per qaly gained, the nmb of pazopanib compared with sunitinib was CA$16,179 (95% cri: CA$4,288 to CA$28,883), CA$19,122 (95% cri: CA$885 to CA$39,268), and CA$22,065 (95% cri: –CA$3,422 to CA$49,494) respectively
Summary
Renal cell carcinomas (rccs) arise in the renal epithelium and account for approximately 85% of all kidney cancers[1]. Systemic immunotherapy involving the use of interferon alfa provided only modest survival benefits to selected patients with advanced rcc, highlighting the need for more effective systemic therapy[4]. The availability of targeted agents for mrcc, including the tyrosine kinase inhibitors pazopanib and sunitinib, and the mtor (mammalian target of rapamycin) inhibitor temsirolimus, has significantly affected treatment of the disease through improvements in response rates, progression-free survival (pfs), and overall survival (os), with manageable side effects[5]. Sunitinib, and temsirolimus is recommended for mrcc in first-line settings in Canada[6]. In Canada and elsewhere, pazopanib and sunitinib—tyrosine kinase inhibitors targeting the vascular endothelial growth factor receptors—are recommended as first-line treatment for patients with metastatic renal cell carcinoma (mrcc). A large randomized noninferiority trial of pazopanib versus sunitinib (comparz) demonstrated that the two drugs have similar efficacy; patients randomized to pazopanib experienced better healthrelated quality of life (hrqol) and nominally lower rates of non-study medical resource utilization
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