OBJECTIVES : Renal cell carcinoma (RCC) is one of the most costly oncological diseases in Russia due to introduction into clinical practice of new targeted drugs that have higher efficacy and cost. The main aim of this study was to perform cost-effectiveness analysis of using sunitinib as first-line therapy in metastatic RCC (mRCC) in adult patients with good or intermediate risk on the basis of the actual practice.

METHODS : Analysis of the published clinical trials was conducted to evaluate comparative efficacy and safety of using different types of first-line therapy used in Russia – sunitinib, pazopanib and interferon-α. MS Excel based Markov model of medical care patients with mRCC with good or intermediate risk has been developed. To measure costs of mRCC treatment with different types of first-line therapy for the state budget were used “cost-effectiveness” analysis (CEA). Direct medical costs included drugs, therapy monitoring, side effects correction, palliative care and were calculated from the Russian healthcare system perspective. The progression free survival (PFS) was included into the model as the effectiveness criteria.

RESULTS : Using of sunitinib compared with pazopanib is associated with a significant increase in the life expectancy of patients with mRCC and a longer expenditure of health system resources. The total direct costs of treatment mRCC per patient were $35472 with sunitinib, $22164 with pazopanib, $4230 with interferon-α. The CEA has shown that in comparison with interferon-α ICER for sunitinib was $46997 and for pazopanib - $47581 per 1 year PFS. The difference amounted to $584 in favor of sunitinib (rate for June 2019).

CONCLUSIONS : Using sunitinib or pazopanib as first-line therapy in mRCC in adult patients with good or intermediate risk were effective and economically justified treatment option in Russia. Respectively, for selecting one of a treatment regimen it is appropriate based on clinical criteria and the individual characteristics of the patient.