Sunitinib is cost-effective in metastatic renal ca patients

BARCELONA—Sunitinib (Sutent) is a cost-effective treatment for metastatic renal cell cancer, according to a report at the 14th European Cancer Conference (ECCO abstract 4514).

The incremental cost-effectiveness ratio for sunitinib vs interferon over 10 years in patients with metastatic renal cell carcinoma of $67,215 per life-year gained and $52,593 per quality-adjusted life-year (QALY) gained is within the established theoretical threshold of $50,000 to $100,000, said Sylvie Negrier, MD, of the Centre Leon Berard, Lyon, France. Actual willingness to pay for targeted cancer therapies, however, varies widely, Dr. Negrier said.

Based on outcomes data

Dr. Negrier's cost-benefit analysis was based on outcomes data—presented by Robert J. Motzer, MD, Memorial Sloan-Kettering Cancer Center (MSKCC) at ASCO 2007 and updated at ECCO—from an international multicenter study directly comparing sunitinib against interferon in 750 patients with previously untreated metastatic renal cancer.

In that clinical trial, better tumor responses in all MSKCC risk factor groups with sunitinib translated into a survival benefit for sunitinib patients (median progression-free survival, 11 months vs 4 months for those on interferon). In addition, sunitinib produced fewer major adverse events.

Both sunitinib and interferon carried a heavy price tag: The total discounted cost for sunitinib, including all ancillary treatments, was $224,970, a roughly 4% increase over the $217,436 cost of interferon.

Dr. Negrier noted that sunitinib treatment would be expected to give an advantage over no treatment of 0.92 progression-free years and 2.09 total life-years. Interferon vs no treatment would give a progression-free survival advantage of 0.51 years, and a total life-year advantage of 1.98 years. The virtue of sunitinib, she said, is therefore in delaying the inevitable progression. Dr. Negrier estimated that sunitinib carries an additional cost of $18,611 per progression-free life-year gained, compared with interferon.

"Best supportive care costs were higher with interferon, while first-line drug costs and routine follow-up costs were higher in the sunitinib-treated patients, due in part to longer-term treatment and survival," Dr. Negrier said.

Projecting costs and benefits over a 10-year span gave an incremental cost-effectiveness ratio for sunitinib vs interferon of $67,215 per life-year gained and $52,593 per QALY gained. "This is well within the established threshold of $50,000 to $100,000 per life-year that society is willing to pay," she said.