Cost-effectiveness Analysis of Sunitinib and Sorafenib Sequential Treatment of Metastatic Renal Cell Carcinoma

抄録

Metastatic renal cell carcinoma (mRCC) often becomes resistant to drugs, and therefore requires sequential treatment with different types of chemotherapeutics. Two agents used for the sequential treatment of mRCC, sunitinib (Su) and sorafenib (So), have been reported to achieve similar clinical efficacy regardless of the sequence in which they are applied. There are differences, however, in the costs associated with regimens. The present study aimed to clarify the optimal administration sequence of Su and So in terms of economic impact from the perspective of public medical care. The health outcomes were analyzed according to overall survival and progression-free survival. The clinical data were drawn from the results of a previous meta-analysis. in 2017. Total costs of each regimen were calculated from direct costs, which were derived from hospital receipts and medical records of patients who were diagnosed with mRCC at Yamagata University Hospital. The cost-effectiveness was analyzed by a Markov chain Monte Carlo method. Long-term patient outcomes and costs were assessed for each treatment option according to the relative incremental cost-effectiveness ratio (ICER). We found that the total gain in life-expectancy and projected cost of each regimen were, respectively, 24.5 months and 22,123,106 yen for Su-So, and 30.0 months and 30,994,113 yen for So-Su. The ICER of So-Su versus that of Su-So was 1,612,910 yen / month, with an incremental effect of 5.5 months. Compared with Su-So, So-Su provided better health outcomes over time; however, the cost was also higher.