An economic evaluation of sunitinib versus interferonalfa and bevacizumab + interferon-alfa in the treatment of metastatic renal cell carcinoma (mRCC) under the perspective of the Brazilian private health system

Abstract

Objective: To perform a cost-effectiveness analysis to compare sunitinib versus interferon-α (IFN-α) and bevacizumab associated to IFN-α (bevacizumab + IFN-α) as first-line treatment of metastatic renal clear cell carcinoma (mRCC), under the perspective of the Brazilian Private Health System. Methods: A Markov model was built to compare the three treatment alternatives for patients with mRCC. The outcomes used were life-years (LY) and progression-free LY (PFLY) gained, in two years time horizon. Epidemiological and efficacy data were obtained from critical appraisal of scientific literature. Data costs were obtained from Revista Kairos for drugs and from CBHPM for exams and procedures. Results are expressed as incremental cost-effectiveness ratios (ICER) or incremental cost per life year saved. Univariate sensitivity analysis was carried out on the main parameters of the model. Results: In comparison with IFN-α, sunitinib increases PFLY and LY by 0,34 and 0,08 years respectively, with ICER of R$ 313.738 per PFLY gained. In comparison to bevacizumab + IFN-α, sunitinib was dominant in both effectiveness measures been more effective and less costly. Conclusion: This model suggests that sunitinib is the most effective drug for the first-line treatment of mRCC Brazilian patients. From the perspective of the Brazilian Private Health Care System, sunitinib is not cost-effective compared to IFN-α and cost-saving compared to bevacizumab + IFN-α.