PMID- 30134758 OWN - NLM STAT- MEDLINE DCOM- 20190409 LR - 20190409 IS - 1941-837X (Electronic) IS - 1369-6998 (Linking) VI - 21 IP - 12 DP - 2018 Dec TI - Cost analysis for different sequential treatment regimens for metastatic renal cell carcinoma in China. PG - 1150-1158 LID - 10.1080/13696998.2018.1515769 [doi] AB - PURPOSE: Targeted therapies, including sunitinib, sorafenib, axitinib, and everolimus, have recently become the mainstay for the treatment of metastatic renal cell carcinoma (mRCC). The objective of this study was to estimate the costs of sequential treatment regimens for mRCC and associated adverse events (AEs) from the Chinese payers' perspective. METHODS: Key inputs included in the calculation were patient population, dosing information, incidence rates and associated costs of Grade 3/4 AEs, treatment costs (including drug discount programs), and patients' progression-free survival (PFS) as a proxy for length of treatment. To calculate PFS, this study identified pivotal clinical trials and generated a reconstructed individual patient data set from the published Kaplan-Meier survival curves. The median PFS from the pooled estimates were used in the calculation. In the base-case scenario, sunitinib was used as first line and the other three therapies were used as second line. Sensitivity analyses were conducted where (1) sorafenib was used as first line, or (2) a third-line therapy was added to the base-case scenario. RESULTS: In the base case, the cost per patient per treatment month (PPPM) cost was the lowest for sunitinib + axitinib among all sequential regimens ( yen14,898) and was the highest for sunitinib + sorafenib ( yen20,103). If sorafenib is used as first line, everolimus had lower per patient per months (PPPM) cost than axitinib ( yen17,046 vs yen23,337), but also had shorter PFS (13.5 months vs 15 months). Second sensitivity analysis with an additional third-line therapy showed consistent results with the base-case scenario; axitinib as second line was the least costly. CONCLUSIONS: This study demonstrates that, for mRCC sequential treatment, sunitinib followed by axitinib generates the highest cost savings from the Chinese payers' perspective. Future studies are warranted to examine the cost-effectiveness of various mRCC treatment regimens in Chinese populations. FAU - Shi, Guohai AU - Shi G AD - a Department of Urology , Fudan University Shanghai Cancer Center , Shanghai , PR China. AD - b Department of Oncology , Shanghai Medical College, Fudan University , Shanghai , PR China. FAU - Park, Sang Hee AU - Park SH AD - c Pharmerit International , Bethesda , MD , USA. FAU - Ren, Hongye AU - Ren H AD - d Pfizer Investment Co., Ltd , Shanghai , PR China. FAU - Xue, Mei AU - Xue M AD - c Pharmerit International , Bethesda , MD , USA. FAU - Lu, Xiaolin AU - Lu X AD - a Department of Urology , Fudan University Shanghai Cancer Center , Shanghai , PR China. AD - b Department of Oncology , Shanghai Medical College, Fudan University , Shanghai , PR China. FAU - Dong, Peng AU - Dong P AD - e Pfizer Investment Co., Ltd , Beijing , PR China. FAU - Gao, Xin AU - Gao X AD - c Pharmerit International , Bethesda , MD , USA. LA - eng PT - Journal Article DEP - 20180910 PL - England TA - J Med Econ JT - Journal of medical economics JID - 9892255 RN - 0 (Antineoplastic Agents) RN - 9HW64Q8G6G (Everolimus) RN - 9ZOQ3TZI87 (Sorafenib) RN - C9LVQ0YUXG (Axitinib) RN - V99T50803M (Sunitinib) SB - IM MH - Aged MH - Antineoplastic Agents/administration & dosage/adverse effects/*economics/*therapeutic use MH - Antineoplastic Combined Chemotherapy Protocols/administration & dosage/adverse effects/*economics/*therapeutic use MH - Axitinib/economics/therapeutic use MH - Carcinoma, Renal Cell/*drug therapy/mortality MH - China MH - Cost-Benefit Analysis MH - Disease-Free Survival MH - Everolimus/economics/therapeutic use MH - Female MH - Humans MH - Kaplan-Meier Estimate MH - Kidney Neoplasms/*drug therapy/mortality MH - Male MH - Middle Aged MH - Models, Econometric MH - Neoplasm Staging MH - Sorafenib/economics/therapeutic use MH - Sunitinib/economics/therapeutic use OTO - NOTNLM OT - Cost analysis OT - I10 OT - I11 OT - axitinib OT - everolimus OT - mRCC OT - sequential treatment OT - sorafenib OT - sunitinib OT - treatment cost EDAT- 2018/08/24 06:00 MHDA- 2019/04/10 06:00 CRDT- 2018/08/24 06:00 PHST- 2018/08/24 06:00 [pubmed] PHST- 2019/04/10 06:00 [medline] PHST- 2018/08/24 06:00 [entrez] AID - 10.1080/13696998.2018.1515769 [doi] PST - ppublish SO - J Med Econ. 2018 Dec;21(12):1150-1158. doi: 10.1080/13696998.2018.1515769. Epub 2018 Sep 10.