Abstract
In the phase iii palette trial of pazopanib compared with placebo in patients with advanced or metastatic soft-tissue sarcoma (sts) who had received prior chemotherapy, pazopanib treatment was associated with improved progression-free survival (pfs). We used an economic model and data from palette and other sources to evaluate the cost-effectiveness of pazopanib in patients with advanced sts who had already received chemotherapy. We developed a multistate model to estimate expected pfs, overall survival (os), lifetime sts treatment costs, and quality-adjusted life-years (qalys) for patients receiving pazopanib or placebo as second-line therapy for advanced sts. Cost-effectiveness was calculated alternatively from the health care system and societal perspectives for the province of Quebec. Estimated pfs, os, incidence of adverse events, and utilities values for pazopanib and placebo were derived from the palette trial. Costs were obtained from published sources. Compared with placebo, pazopanib is estimated to increase qalys by 0.128. The incremental cost of pazopanib compared with placebo is CA$20,840 from the health care system perspective and CA$15,821 from the societal perspective. The cost per qaly gained with pazopanib in that comparison is CA$163,336 from the health care system perspective and CA$124,001 from the societal perspective. Compared with placebo, pazopanib might be cost-effective from the Canadian health care system and societal perspectives depending on the threshold value used by reimbursement authorities to assess novel cancer therapies. Given the unmet need for effective treatments for advanced sts, pazopanib might nevertheless be an appropriate alternative to currently used treatments.
Highlights
Soft-tissue sarcomas are rare solid tumours that comprise more than 50 histologic subtypes originating from mesenchymal cells and their precursors and that affect extraskeletal connective tissue including muscle, fatty tissue, nerves, fibrous tissue, blood vessels, and cartilage[1,2]
We developed a multistate model to estimate expected pfs, overall survival, lifetime sts treatment costs, and quality-adjusted life-years for patients receiving pazopanib or placebo as second-line therapy for advanced sts
Pazopanib might be costeffective from the Canadian health care system and societal perspectives depending on the threshold value used by reimbursement authorities to assess novel cancer therapies
Summary
Soft-tissue sarcomas (stss) are rare solid tumours that comprise more than 50 histologic subtypes originating from mesenchymal cells and their precursors and that affect extraskeletal connective tissue including muscle, fatty tissue, nerves, fibrous tissue, blood vessels, and cartilage[1,2]. Most patients diagnosed with sts eventually develop local recurrence or metastases after initial treatment[5,6]. The standard of care for first-line systemic treatment of most asts subtypes is an anthracycline, typically doxorubicin, alone or in combination with ifosfamide[6,8,9]. Results from a retrospective chart review of asts patients in North America and Europe found that the most frequently used secondline therapy was gemcitabine plus docetaxel, followed by ifosfamide monotherapy[12]. In the phase iii palette trial of pazopanib compared with placebo in patients with advanced or metastatic soft-tissue sarcoma (sts) who had received prior chemotherapy, pazopanib treatment was associated with improved progression-free survival (pfs). We used an economic model and data from palette and other sources to evaluate the cost-effectiveness of pazopanib in patients with advanced sts who had already received chemotherapy
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