Abstract
OBJECTIVES: To estimate the cost-effectiveness of sorafenib (Nexavar, Bayer, Leverkusen, Germany) versus best supportive care (BSC) for second-line treatment of advanced renal cell carcinoma from the perspective of the UK National Health Service.
METHODS: A decision analytic model was developed to estimate the cost-effectiveness of sorafenib. The clinical effectiveness of sorafenib versus BSC was taken from a recent randomized phase III trial. Utility values were taken from a phase II trial of sunitinib, using EQ-5D tariffs. Cost data were obtained from published literature and were based on current UK practice. The effect of parameter uncertainty on cost-effectiveness was explored through extensive one-way and probabilistic sensitivity analyses.
RESULTS: Compared to BSC, sorafenib treatment resulted in an incremental cost per quality-adjusted life year (QALY) gained of pound75,398, based on an estimated mean gain of 0.27 QALYs per patient, at a mean additional cost of pound20,063 (inflated to 2007/2008). The probability that sorafenib is cost-effective compared to BSC at a willingness to pay threshold of pound30,000 per QALY is 0.0%. In sensitivity analysis, estimates of cost per QALY were sensitive to changes in the clinical effectiveness parameters, and to health state utilities and drug costs.
CONCLUSIONS: Sorafenib has been shown to be clinically effective compared to BSC, offering additional health benefits; however, with a cost per QALY in excess of pound70,000, it may not be regarded as a cost-effective use of resources in some health-care settings.
Original language | English |
---|---|
Pages (from-to) | 55-60 |
Number of pages | 6 |
Journal | Value in Health |
Volume | 13 |
Issue number | 1 |
DOIs | |
Publication status | Published - 7 Oct 2009 |
Keywords
- Antineoplastic Agents
- Benzenesulfonates
- Carcinoma, Renal Cell
- Chemotherapy, Adjuvant
- Cost-Benefit Analysis
- Decision Support Techniques
- Disease Progression
- Great Britain
- Humans
- Kidney Neoplasms
- Markov Chains
- Models, Statistical
- National Health Programs
- Niacinamide
- Phenylurea Compounds
- Pyridines
- Quality-Adjusted Life Years