ECONOMIC EVALUATION OF SUNITINIB VS. IMATINIB IN SECOND LINE FOR GASTROINTESTINAL TUMOR (GIST) IN BRAZIL

OBJECTIVES The second line options for patients with GIST on imanitib 400 mg/ day, whose tumor continued to progress is: imatinib dose increased to 600 mg/day followed by another increase to 800 mg/day. In case of intolerance, only palliative treatment was available. In these cases, TTP was not higher than 6.4 weeks. Sunitinib malate consists of a new therapeutic alternative for this unmet medical need. The objective of this economic evaluation was to estimate the costs and outcomes for GIST treatment with sunitinib, compared with best supportive care (BSC) and imatinib 800 mg/day, under the Brazilian public health care system perspective METHODS A Markov model was developed, with a maximum of 6 years time horizon, to simulate the costs and outcomes associated to GIST treatment, considering healthcare resources from the Brazilian Public Health Care System perspective (SUS). The model considers disease progression, death from all causes, adverse events and dose decrease needs every 6 weeks cycles. Results were expressed as life-years (LY) gained, progression-free LY (PFLY) gained, treatment costs, and incremental cost-effectiveness ratios (ICER) RESULTS In comparison with BSC, sunitinib increases LY and PFLY by 0.3 and 0.26 years respectively, with incremental costs of R$86,756 (US$61,968 Purchasing Power Parity 2005, 1US$=1,4R$) In comparison with imatininb, sunitinib was both more effective (with 0.02 LY and 0.47 PFLY gained) and less costly over 6 years. CONCLUSIONS This model suggests that when taking the perspective of the Brazilian Public Health Care System (SUS), sunitinib is a cost-effective alternative when compared with imatinib 800 mg/day in a 6 years time horizon. In comparison to BSC, sunitinib promoted better results on efficacy parameters, with an incremental cost in the same time horizon