Cost-Effectiveness of Pazopanib Compared to Sunitinib In the Treatment of Metastatic Renal Cell Carcinoma

Renal cell carcinoma (RCC) accounts for 2%–3% of all adult malignancies. In Egypt, RCCs represent 0.8% of all newly diagnosed cancers. Vascular endothelial growth factor inhibitors as Pazopanib and Sunitinib, have demonstrated a better progression-free survival in treatment of mRCC. This research aims to assess the cost-effectiveness of Pazopanib compared to Sunitinib as a first-line treatment for patients with metastatic RCC (mRCC) from the perspective of Egyptian health care system. A Markov state transition model was developed to perform a cost-utility analysis to compare the cost and health benefits of Pazopanib to that of Sunitinib in treatment of mRCC; a cohort simulation approach was used. The Markov model consisted of three health states—alive with no progression (pre-progression), alive with progression (post-progression), and dead. Expected lifetime costs (including medication costs, dispensing/administration costs, other costs associated with Pazopanib and Sunitinib treatment, routine follow-up, monitoring and supportive care costs, and total costs), life-years, and quality-adjusted life-years (QALYs) were calculated for treatment-naïve patients receiving Pazopanib and Sunitinib as a first-line treatment for mRCC; based on data from the Egyptian Health Insurance Organization. The model cycle length was set at one month, which was chosen to accommodate the 4-week treatment cycle for Pazopanib and the 6-week treatment cycle for Sunitinib and to avoid the need for a half-cycle correction. The incremental cost-effectiveness ratio (ICER) for Pazopanib versus Sunitinib was calculated. Sensitivity analyses were performed using a 10-years’ time horizon. All costs were estimated in Egyptian Pound (EGP). The incremental cost per QALY gained was estimated for Pazopanib as 53,481 EGP, and as 69,436 EGP for Sunitinib in treatment of mRCC. The ICER was – 4,580,428. Moreover, Pazopanib was cost-saving compared to Sunitinib. The Pazopanib was cost-effective and cost-saving compared to Sunitinib as a first line treatment for mRCC form the Egyptian health care system.