Abstract
e15136 Background: Currently, there are several agents used to treat metastatic renal cell carcinoma (mRCC). However, limited studies comparing cost analysis among these available agents. Here we conducted a cost analysis of mRCC treatments in Thailand to determine the economic implications of these agents. Methods: A life-time Markov model was developed to simulate the patterns of disease progression and to determine the outcomes under treatment of available medicines including interferon-alpha (IFNa), sunitinib, sorafenib, and bevacizumab. Costs were measured based on the perspective of a healthcare provider. Resource utilization derived from retrospective chart reviews of 14 mRCC patients treated at the King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Costs and survival benefits were discounted annually at 3%. Results: The major assumption of the study was that the projected PFS and overall survival were longer for sunitinib than the other comparative treatments based on results of published studies. Cost-effectiveness analyses demonstrated that IFNa had the most favourable cost-effectiveness ratio at 1.3 Million Baht/QALYs followed by sunitinib, sorafenib, and bevacizumab at 1.7, 1.9, 9.3 Million Baht/QALYs respectively. However, sunitinib had a better incremental cost-effectiveness ratios (ICERs) over IFNa at 2.0 million Baht/PFY, 2.7 million Baht/LYG, and 3.6 million Baht/QALY gained. Both of sorafenib and bevacizumab plus IFNa cost-effectiveness were outperformed by sunitinib. Sensitivity analysis showed that the most sensitive parameters for sunitinib were the overall survivalefficacy and costs. Conclusions: Our study reveals that sunitinib has the good cost-effectiveness profiles as one of the first line treatment of mRCC. With current study model, it may be applicable to the situation in developing country with limit availability of TKIs in the treatment of mRCC. However, sunitinib's ICER comparing to IFNa is still beyond the ICER threshold for a developing country. This cost-effectiveness evidence should be taken into account in conjunction with other clinical, societal, and ethical considerations in the treatment of mRCC. No significant financial relationships to disclose.
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