A COST EFFECTIVNESS ANALYSIS OF EVEROLIMUS COMPARED WITH AXITINIB IN THE TREATMENT OF METASTATIC RENAL CELL CARCINOMA IN THE UNITED KINGDOM

OBJECTIVES This study assessed the cost-effectiveness of everolimus versus axitinib for the treatment of advanced metastatic renal cell carcinoma (mRCC) in the United Kingdom (UK). METHODS A Markov model was developed with three health states: stable disease, disease progression and death. The model time horizon was 12 years and a UK NHS perspective was considered. There are no head to head studies comparing everolimus with axitinib, thus evidence from a weighted adjusted indirect analysis based on the RECORD-1 and AXIS trials was used to compare progression-free survival (PFS) for everolimus versus axitinib. Survival distributions for PFS were fitted to the post-matched population and fit statistics were generated. As overall survival (OS) data were not available from the AXIS trial at the time of the indirect analysis, the model assumed that the OS for axitinib was equivalent to that of everolimus, based on OS from the RECORD-1 trial. The Weibull survival distribution was used for both PFS and OS. Quality of life data were derived from the Swinburn et al. study and drug costs were obtained from the British National Formulary. RESULTS Everolimus resulted in a progression-free life expectancy of 0.60 years compared to 0.57 with axitinib. Everolimus resulted in 0.65 QALYs compared to 0.63 QALYs for axitinib. Active drug costs were £8,105 for everolimus and £25,723 for axitinib. Total costs were higher for axitinib (£42,533) compared to everolimus (£24,387). The cost difference reflects the higher treatment costs per month and longer treatment duration for axitinib compared to everolimus. Therefore, the incremental cost of axitinib compared with axitinib was -£18,146, highlighting that everolimus is less expensive. The incremental cost per QALY gained was -£1,048,954. CONCLUSIONS This cost-effectiveness analysis demonstrates that everolimus likely dominates axitinib, i.e. it is more effective and less expensive compared with axitinib in the treatment of mRCC.