Abstract
BackgroundTo estimate, from the perspective of the Chinese healthcare system, the economic outcomes of five different first-line strategies among patients with metastatic renal cell carcinoma (mRCC).Methods and FindingsA decision-analytic model was developed to simulate the lifetime disease course associated with renal cell carcinoma. The health and economic outcomes of five first-line strategies (interferon-alfa, interleukin-2, interleukin-2 plus interferon-alfa, sunitinib and bevacizumab plus interferon-alfa) were estimated and assessed by indirect comparison. The clinical and utility data were taken from published studies. The cost data were estimated from local charge data and current Chinese practices. Sensitivity analyses were used to explore the impact of uncertainty regarding the results. The impact of the sunitinib patient assistant program (SPAP) was evaluated via scenario analysis. The base-case analysis showed that the sunitinib strategy yielded the maximum health benefits: 2.71 life years and 1.40 quality-adjusted life-years (QALY). The marginal cost-effectiveness (cost per additional QALY) gained via the sunitinib strategy compared with the conventional strategy was $220,384 (without SPAP, interleukin-2 plus interferon-alfa and bevacizumab plus interferon-alfa were dominated) and $16,993 (with SPAP, interferon-alfa, interleukin-2 plus interferon-alfa and bevacizumab plus interferon-alfa were dominated). In general, the results were sensitive to the hazard ratio of progression-free survival. The probabilistic sensitivity analysis demonstrated that the sunitinib strategy with SPAP was the most cost-effective approach when the willingness-to-pay threshold was over $16,000.ConclusionsOur analysis suggests that traditional cytokine therapy is the cost-effective option in the Chinese healthcare setting. In some relatively developed regions, sunitinib with SPAP may be a favorable cost-effective alternative for mRCC.
Highlights
Renal cell carcinoma (RCC), the most common type of kidney cancer, accounts for about 3% of all human malignancies
Our analysis suggests that traditional cytokine therapy is the cost-effective option in the Chinese healthcare setting
Much longer periods of progression-free survival (PFS) achieved by the targeted therapies resulted in longer survival times with more quality-adjusted life-year (QALY) than could be achieved with cytokine therapies
Summary
Renal cell carcinoma (RCC), the most common type of kidney cancer, accounts for about 3% of all human malignancies. It is estimated that nearly 30% of the patients with RCC have distant metastatic disease at presentation and that half of those with localised disease subsequently develop metastases during the course of their disease [1,2]. The median overall survival for metastatic RCC patients is 10 months, and the 5-year survival rate is 5–15%, even when all visible disease is cleared by metastasectomy and nephrectomy [3,4]. The most widely used regimens for metastatic RCC (mRCC) are cytokine therapies, including interferon-alfa and interleukin-2, which in previous studies showed response rates of only 10–20% and resulted in debilitating adverse effects [5,6,7]. From the perspective of the Chinese healthcare system, the economic outcomes of five different first-line strategies among patients with metastatic renal cell carcinoma (mRCC)
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