Cost analysis for different sequential treatment regimens for metastatic renal cell carcinoma in China

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.

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, we 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 3 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.

In the base case, the cost per patient per treatment month (PPPM) cost was the lowest for sunitinib + axitinib among all sequential regimens (¥14,898) and was the highest for sunitinib + sorafenib (¥20,103). If sorafenib is used as first line, everolimus had lower per patient per months (PPPM) cost than axitinib (¥17,046 vs. ¥23,337) 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.

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.

Journal of medical economics. 2018 Aug 22 [Epub ahead of print]

Guohai Shi, Sang Hee Park, Hongye Ren, Mei Xue, Xiaolin Lu, Peng Dong, Xin Gao

a Department of Urology , Fudan University Shanghai Cancer Center , Shanghai , China., c Pharmerit International , Bethesda, Maryland , USA., d Pfizer Investment Co., Ltd , Shanghai , China., e Pfizer Investment Co., Ltd , Beijing , China.