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Economic Evaluation of First-Line Treatments for Metastatic Renal Cell Carcinoma: A Cost-Effectiveness Analysis in A Health Resource–Limited Setting

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  • Bin Wu
  • Baijun Dong
  • Yuejuan Xu
  • Qiang Zhang
  • Jinfang Shen
  • Huafeng Chen
  • Wei Xue

Abstract

Background: To estimate, from the perspective of the Chinese healthcare system, the economic outcomes of five different first-line strategies among patients with metastatic renal cell carcinoma (mRCC). Methods and Findings: A decision-analytic model was developed to simulate the lifetime disease course associated with renal cell carcinoma. The health and economic outcomes of five first-line strategies (interferon-alfa, interleukin-2, interleukin-2 plus interferon-alfa, sunitinib and bevacizumab plus interferon-alfa) were estimated and assessed by indirect comparison. The clinical and utility data were taken from published studies. The cost data were estimated from local charge data and current Chinese practices. Sensitivity analyses were used to explore the impact of uncertainty regarding the results. The impact of the sunitinib patient assistant program (SPAP) was evaluated via scenario analysis. The base-case analysis showed that the sunitinib strategy yielded the maximum health benefits: 2.71 life years and 1.40 quality-adjusted life-years (QALY). The marginal cost-effectiveness (cost per additional QALY) gained via the sunitinib strategy compared with the conventional strategy was $220,384 (without SPAP, interleukin-2 plus interferon-alfa and bevacizumab plus interferon-alfa were dominated) and $16,993 (with SPAP, interferon-alfa, interleukin-2 plus interferon-alfa and bevacizumab plus interferon-alfa were dominated). In general, the results were sensitive to the hazard ratio of progression-free survival. The probabilistic sensitivity analysis demonstrated that the sunitinib strategy with SPAP was the most cost-effective approach when the willingness-to-pay threshold was over $16,000. Conclusions: Our analysis suggests that traditional cytokine therapy is the cost-effective option in the Chinese healthcare setting. In some relatively developed regions, sunitinib with SPAP may be a favorable cost-effective alternative for mRCC.

Suggested Citation

  • Bin Wu & Baijun Dong & Yuejuan Xu & Qiang Zhang & Jinfang Shen & Huafeng Chen & Wei Xue, 2012. "Economic Evaluation of First-Line Treatments for Metastatic Renal Cell Carcinoma: A Cost-Effectiveness Analysis in A Health Resource–Limited Setting," PLOS ONE, Public Library of Science, vol. 7(3), pages 1-13, March.
    • Handle: RePEc:plo:pone00:0032530
    DOI: 10.1371/journal.pone.0032530
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    References listed on IDEAS

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    1. Corrado Barbui & Tarun Dua & Mark van Ommeren & M Taghi Yasamy & Alexandra Fleischmann & Nicolas Clark & Graham Thornicroft & Suzanne Hill & Shekhar Saxena, 2010. "Challenges in Developing Evidence-Based Recommendations Using the GRADE Approach: The Case of Mental, Neurological, and Substance Use Disorders," PLOS Medicine, Public Library of Science, vol. 7(8), pages 1-8, August.
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    1. Xiaohui Zeng & Jonathan Karnon & Siying Wang & Bin Wu & Xiaomin Wan & Liubao Peng, 2012. "The Cost of Treating Advanced Non-Small Cell Lung Cancer: Estimates from the Chinese Experience," PLOS ONE, Public Library of Science, vol. 7(10), pages 1-7, October.
    2. Chongqing Tan & Liubao Peng & Xiaohui Zeng & Jianhe Li & Xiaomin Wan & Gannong Chen & Lidan Yi & Xia Luo & Ziying Zhao, 2013. "Economic Evaluation of First-Line Adjuvant Chemotherapies for Resectable Gastric Cancer Patients in China," PLOS ONE, Public Library of Science, vol. 8(12), pages 1-1, December.

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