OBJECTIVES:

Sonidegib and vismodegib are indicated for the treatment of adult patients with locally advanced Basal Cell Carcinoma not amenable to surgery or radiotherapy. While both drugs were approved based on single-arm trials, their comparative effectiveness has been established in a matching-adjusted indirect comparison by Odom et al. (2017). The cost-effectiveness of sonidegib vs. vismodegib has initially been examined with focus on the UK by Purser et al. (2016). Our research takes a look at the relative cost-effectiveness of both drugs in the context of the national Swedish payer setting (TLV).

METHODS:

The partitioned-survival model (PFS, progressive disease, death) of sonidegib vs. vismodegib described by Purser et al. (2016) has been adapted to reflect the background of the Swedish healthcare system. Model outcomes include expected costs, life years, QALYs and ICER. Price parity between both drugs on a DDD basis is assumed. Costs for adverse event monitoring and treatment as well as physician visits have been evaluated based on the regional prices and compensation for the Southern Healthcare Region 2020 (Regionala priser och ersättningar för Södra Sjukvårdsregionen 2020), costs for lab analyses were based on the Skåne region tariffs (Medicinsk service, Labmedicin, Region Skåne 2020). The model considers a lifetime horizon. Health outcomes and costs were discounted by 3.0% per year.

RESULTS:

Total discounted costs per person over a lifetime horizon were 2,567,817 SEK for sonidegib and 2,692,955 SEK for vismodegib. Discounted QALYs expected were 8.22 vs. 8.10 for sonidegib and vismodegib respectively. The resulting ICER was -987,829 SEK per QALY gained in favour of sonidegib.

CONCLUSIONS:

Our results confirm the dominance of sonidegib vs. vismodegib (improvement in QALYs along with a reduction in costs) in the Swedish national payer setting. Robustness to parameter uncertainty and variability was confirmed in sensitivity analyses.