Cost effectiveness of sorafenib versus best supportive care in advanced renal cell carcinoma in Canada

Abstract

5111 Background: Sorafenib is an oral multi-kinase inhibitor that targets tumour cell proliferation and tumour angiogenesis. In the TARGETs study (phase III trial), sorafenib plus best supportive care (BSC) significantly prolonged progression-free survival (PFS) compared with BSC alone (P<0.000001) in patients with advanced renal cell carcinoma (RCC). The objective of this study was to evaluate the costeffectiveness of sorafenib plus BSC versus BSC alone in advanced RCC from a Canadian provincial Ministry of Health perspective. Methods: A Markov model was developed to project the lifetime survival and costs associated with the two treatment groups. The model tracked patients with advanced RCC through three disease states - PFS, progression, and death. Resource utilization included drug, drug administration, physician visits, monitoring, and adverse events. Costs and survival benefits were discounted annually at 5%. Results: The lifetime per patient costs were $62,426 CDN and $18,898 CDN for sorafenib + BSC and BSC alone, respectively. The life-years gained (LYG) were higher for sorafenib relative to BSC. The incremental cost-effectiveness ratio (ICER) of sorafenib plus BSC versus BSC alone over a lifetime horizon was $36,046/LYG CDN (with a half cycle correction). Univariate sensitivity analyses yielded ICERs below $70,000/LYG CDN. Probabilistic sensitivity analyses showed that the results were moderately sensitive to the clinical variables and less sensitive to the cost variables, yielding ICERs below $100,000/LYG CDN in most cases. Conclusion: Sorafenib is cost effective with an ICER of $36,046/LYG CDN which is below the suggested cost effectiveness threshold of $100,000/QALY ($CDN 1992) or $130,860/QALY ($CDN 2006). [Table: see text]