COST-EFFECTIVENESS ANALYSIS OF SUNITINIB VERSUS INTERFERON ALFA FOR THE FIRST-LINE TREATMENT OF ADVANCED AND/OR METASTATIC RENAL CELL CARCINOMA IN SINGAPORE
Author(s)
Pruis S, Pearce F, Abdul Aziz MI, Wu DB, Ng KH
Agency for Care Effectiveness, Ministry of Health, Singapore, Singapore, Singapore
Presentation Documents
OBJECTIVES: To evaluate the cost-effectiveness of sunitinib compared to interferon alfa for the first-line treatment of advanced and/or metastatic renal cell carcinoma (RCC) in Singapore. METHODS: A partitioned survival model with three health states (progression-free, progressive disease and death) was developed from a healthcare payer perspective. Survival curves from the sunitinib pivotal trial (sunitinib versus interferon alfa) were extrapolated beyond the trial period to estimate the underlying progression-free survival and overall survival parametric distributions. Health state utilities were derived from the literature in the absence of local estimates and direct costs were sourced from public healthcare institutions in Singapore. A discount rate of 3% was applied to both costs and outcomes. Incremental cost-effectiveness ratios (ICERs) were calculated over a 10 year time horizon. One-way deterministic and probabilistic sensitivity analyses were conducted to explore uncertainties. RESULTS: The base-case analysis comparing sunitinib versus interferon alfa resulted in an ICER of $191,000 per quality-adjusted life year (QALY). The ICER was sensitive to the utility weights and hazard ratios for overall survival, however, when parameters were varied in sensitivity analyses, none of the ICERs fell within a range which would be deemed cost-effective in the local setting. CONCLUSIONS: While sunitinib is clinically more effective than interferon alfa in prolonging progression free survival in RCC, it is also considerably more costly in Singapore’s context. Consequently, when compared with interferon alfa, it is unlikely to represent a cost-effective use of healthcare resources at the current price. Results from this cost-effectiveness analysis will help inform our ongoing health technology assessment of tyrosine kinase inhibitors for RCC. In addition to cost-effectiveness, other factors including clinical effectiveness, safety and budget impact will also need to be taken into account when making recommendations for national subsidy.
Conference/Value in Health Info
2018-09, ISPOR Asia Pacific 2018, Tokyo, Japan
Value in Health, Vol. 21, S2 (September 2018)
Code
PCN42
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Oncology, Urinary/Kidney Disorders