Economic evaluation of sunitinib malate in second-line treatment of metastatic renal cell carcinoma in Finland

Background: Cytokine therapy is currently used as first-line treatment of metastatic renal cell carcinoma (mRCC). Until recently, treatments with proven efficacy after the failure of first-line cytokine therapy were not available. In recent clinical trials, sunitinib has been associated with good response rates in patients with mRCC. Objective: The aim of this study was to analyze the cost-effectiveness of sunitinib as second-line therapy for cytokine-refractory mRCC compared with current routine clinical practice in Finland (ie, best supportive care [BSC], including palliative biochemotherapy). Methods: A probabilistic decision-analytic model was developed to estimate the cost-effectiveness of sunitimb. Data were gathered from clinical trials, literature sources, and expert opinions, as well as from a local sample (n = 39) from 2 university hospitals in Finland. Clinical experts treating patients with mRCC in Finland provided the information on care practices of prescribing sunitinib. The analysis was conducted from the perspective of the health care payer in Finland. Results: According to estimated incremental cost-effectiveness ratios (ICERs), 1 progression-free month gained cost epsilon 4802 (2005 Euros); I life-year gained cost epsilon 30,831; and 1 quality-adjusted life-year (QALY) gained cost epsilon 43,698, compared with BSC, in the treatment of mRCC. The expected mean cost in BSC was epsilon 5543. When parameter uncertainty was considered, the probability of sunitimb being the more cost-effective choice of treatment was similar to 70% at the willingness-to-pay level of epsilon 45,000/QALY gained. Conclusions: Based on the results of this cost-effectiveness analysis, sunitimb is potentially cost-effective as a second-line treatment of mRCC compared with the treatment currently practiced in Finnish hospitals. The ICER (epsilon/QALY gained) obtained in the present study was less than the value considered suitable for novel oncology treatments.