OBJECTIVES: Renal cell carcinoma (RCC) constitutes 80 to 85 percent of primary renal neoplasms with a variable incidence over the world and the median age of 65 years. Sorafenib (SFN) is a multi-kinase inhibitor which fares better than other treatment strategies for RCC including surgery and systemic chemotherapy. This study was aimed to systematically review the economic evaluations of SFN in the treatment of RCC to assist decision-makers in controlling costs and ensuring access to effective treatments within limited healthcare budgets.

METHODS: A systematic review was conducted in major databases including PubMed, Cochrane, Embase, Google scholar, Scopus, and Web of Science up to June 2018 with limitation to English full-text published articles. Articles were selected on the basis of their dealing with the economic evaluations of SFN. The quality of the selected studies was assessed using the Quality of Health Economic Studies (QHES) instrument.

RESULTS: Five articles were identified in databases meeting the inclusion/exclusion criteria. Two of them had compared sunitinib versus SFN and becacizumab plus interferon-α, one had compared SFN versus everolimus, and the other two had compared SFN versus best supportive care (BSC). This review revealed incremental costs per quality-adjusted life years in the range of US$ 89,160 to US$ 118,825, depending on whether the setting was first-line or second-line and which comparator is utilized. The results indicated that SFN had not been considered as an appropriate treatment option for patients with metastatic RCC. SFN was dominated (i.e. higher cost and lower efficacy) in comparison with sunitinib in all cases. However, it was revealed that SFN would be cost-effective in comparison with bevacizumab plus interferon alfa in the treatment of metastatic RCC with lower cost and lower efficacy.

CONCLUSIONS: SFN was more effective with higher cost than sunitinib and BSC but was not cost-effective in view of acceptable willingness to pay thresholds.