Cost-effectiveness of sunitinib or pazopanib for metastatic renal cell carcinoma in Brazil: A public health system perspective.

Abstract

680 Background: The first-line treatment with tyrosine kinase inhibitors results in significant clinical benefits for patients with metastatic renal cell carcinoma (mRCC). However, in Brazilian public health system Interferon still remains as standard treatment. In an innovative way, the Brazilian Society of Clinical Oncology made a price negotiation directly with the pharmaceutical company, aiming to propose a formal request for the incorporation of these technologies to the National Committee for Health Technology Incorporation (CONITEC). Our objective was to estimate the cost-effectiveness of Sunitinib or Pazopanib versus Interferon in patients with mRCC, under the perspective of the Brazilian public health system. Methods: A cost-effectiveness analysis was conducted using a Markov model over a lifetime horizon. The model considers three health states: 1st-line treatment, disease progression and death. Transition probabilities were extracted from randomized studies. Costs of standard treatment, complications, and surveillance were obtained from Brazilian public hospitals. Sunitinib and Pazopanib prices were those negotiated with the manufacturing companies. Benefits are presented in life-years (LY) and costs in USD. The relation between costs and benefits were used to present the incremental cost-effectiveness ratio (ICER) per life-year saved. Results: Patients with mRCC treated with Interferon were projected to have 1.92 LY with a total cost of $2,000. Sunitinib or Pazopanib were projected to increase the life expectancy to 2.84 LY, with a total cost of $19,584 (Sunitinib) and $19,646 (Pazopanib). The ICERs for Sunitinib and Pazopanib were estimated at $18,565 and $18,634 per LY respectively. Conclusions: Using the discount prices, at a willingness-to-pay (WTP) threshold of $25,615 per LY (three times gross domestic product per capita), both Pazopanib and Sunitinib are cost-effective strategies compared to Interferon. Potential impacts of targeted therapies for mRCC on the overall health care expenditures need to be assessed in a budget impact analysis. A formal request for the incorporation of these technologies to the CONITEC is in progress.