PMID- 18711190
OWN - NLM
STAT- MEDLINE
DCOM- 20080902
LR  - 20220331
IS  - 1527-7755 (Electronic)
IS  - 0732-183X (Linking)
VI  - 26
IP  - 24
DP  - 2008 Aug 20
TI  - Economic evaluation of sunitinib malate for the first-line treatment of 
      metastatic renal cell carcinoma.
PG  - 3995-4000
LID - 10.1200/JCO.2007.13.2662 [doi]
AB  - PURPOSE: To assess the cost effectiveness and cost utility of sunitinib malate as 
      a first-line treatment in metastatic renal cell carcinoma (mRCC) compared with 
      interferon-alfa (IFN-alpha) and interleukin-2 (IL-2) from a US societal 
      perspective. METHODS: A Markov model was developed to simulate disease 
      progression and to determine progression-free survival, total life-years (LYs), 
      and quality-adjusted life-years (QALYs) gained. Model parameters were derived 
      from the pivotal trial of sunitinib, published literature, government sources, 
      and clinical experts' opinions. The model included trial-based adverse events 
      (AEs). Costs of drug treatment, routine follow-up, AEs, disease progression, and 
      best supportive care (BSC) of terminally ill patients were included. Results were 
      tested using probabilistic and deterministic sensitivity analyses. RESULTS: 
      Treatment with sunitinib is associated with a gain in progression-free years of 
      0.41 and 0.35 over IFN-alpha and IL-2. The estimated gains over IFN-alpha were 
      0.11 LYs and 0.14 QALYs, and over IL-2 were 0.24 LYs and 0.20 QALYs. Both 
      IFN-alpha and sunitinib treatments dominate IL-2 treatment; the incremental 
      cost-effectiveness ratio of sunitinib versus IFN-alpha was $18,611 per 
      progression-free year gained and $67,215 per LY gained, and the cost-utility 
      ratio is $52,593 per QALY gained (at a 5% discount rate). Sensitivity analyses 
      found the results to be most sensitive to utility values during treatment, the 
      cost of sunitinib, and the cost of BSC. Model results were robust to changes in 
      other model variables. CONCLUSION: These results suggest that sunitinib is a 
      cost-effective alternative to IFN-alpha as a first-line treatment for mRCC.
FAU - Remak, Edit
AU  - Remak E
AD  - Health Care Analytics, United BioSource Corp, 20 Bloomsbury Square, London WC1A 
      2NS, United Kingdom. edit.remak@unitedbiosource.com
FAU - Charbonneau, Claudie
AU  - Charbonneau C
FAU - Negrier, Sylvie
AU  - Negrier S
FAU - Kim, Sindy T
AU  - Kim ST
FAU - Motzer, Robert J
AU  - Motzer RJ
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Clin Oncol
JT  - Journal of clinical oncology : official journal of the American Society of 
      Clinical Oncology
JID - 8309333
RN  - 0 (Antineoplastic Agents)
RN  - 0 (Indoles)
RN  - 0 (Interferon-alpha)
RN  - 0 (Interleukin-2)
RN  - 0 (Pyrroles)
RN  - V99T50803M (Sunitinib)
SB  - IM
MH  - Antineoplastic Agents/*economics/*therapeutic use
MH  - Carcinoma, Renal Cell/*drug therapy/pathology
MH  - Cost-Benefit Analysis
MH  - Disease-Free Survival
MH  - Drug Costs
MH  - Humans
MH  - Indoles/*economics/*therapeutic use
MH  - Interferon-alpha/economics/therapeutic use
MH  - Interleukin-2/economics/therapeutic use
MH  - Kidney Neoplasms/*drug therapy/pathology
MH  - Managed Care Programs/economics
MH  - Markov Chains
MH  - Models, Economic
MH  - Neoplasm Metastasis
MH  - Pyrroles/*economics/*therapeutic use
MH  - Quality-Adjusted Life Years
MH  - Sunitinib
MH  - Survival Rate
EDAT- 2008/08/20 09:00
MHDA- 2008/09/03 09:00
CRDT- 2008/08/20 09:00
PHST- 2008/08/20 09:00 [pubmed]
PHST- 2008/09/03 09:00 [medline]
PHST- 2008/08/20 09:00 [entrez]
AID - 26/24/3995 [pii]
AID - 10.1200/JCO.2007.13.2662 [doi]
PST - ppublish
SO  - J Clin Oncol. 2008 Aug 20;26(24):3995-4000. doi: 10.1200/JCO.2007.13.2662.