Proposal for a novel methodology to screen and score cost versus survival for anticancer drugs in metastatic disease: could cost weigh in evaluation?

PURPOSE

Rising costs of anticancer drugs prompt concerns about their approval, use, and affordability. A methodology was developed to evaluate cost versus survival for anticancer drugs in metastatic breast cancer and non-small-cell lung cancer (NSCLC).

METHODS

Costs of evaluated drugs were calculated by using average wholesale prices in US dollars. Ratios of cost to day of survival (cost/survival/d) were obtained by dividing costs of the entire treatment by reported median survival gain in days. A crude score of 100% was assigned to a cost/survival/d of less than $25, and 0% to a cost/survival/d of more than $750. A strategy was designed to correct for overall survival (OS) versus progression-free survival (PFS), adverse effects, and quality of life.

RESULTS

In breast cancer, PFS scores of bevacizumab varied between 0% and 60%. In NSCLC, OS scores of bevacizumab improved from 0% to 50%, as a result of histology, lower prices, and extended therapy. Gefitinib and erlotinib PFS scores were 80% and 70%, respectively. Correction for longer survival with erlotinib resulted in similar scores. In maintenance therapy, the OS score for pemetrexed was 70% as compared with 25% for erlotinib. Generic drugs scored 70% to 90%.

CONCLUSION

Cost/survival varied with the number of cycles. In breast cancer, bevacizumab scores failed to justify its use. In NSCLC, 10 cycles of bevacizumab scored 0%. Scores improved with extended treatment and lower prices. Scores for gefitinib and erlotinib would support their approval. Erlotinib was preferred because of longer PFS. Results tended to endorse maintenance pemetrexed but not erlotinib. Generic drugs demonstrated high scores. Cost/survival could weigh in drug evaluation.

Cost-effectiveness of sunitinib in metastatic renal cell carcinoma

Sunitinib is one of the first targeted treatments for metastatic renal cell carcinoma (mRCC) and is currently considered as the standard of care for most of the mRCC patients in the first-line setting. The introduction of targeted treatments has, in the past few years, led to improvements in disease management and survival of these patients, however, with increasing cost. Cost-effectiveness of sunitinib has been assessed on several occasions and a systematic literature search was conducted to find all published research articles as well as all research abstracts presented in various congresses. This article presents an overview of the currently existing cost-effectiveness studies of sunitinib in mRCC, along with the main results and the utilized methodology. In most of the economic evaluations sunitinib has been deemed to be a cost-effective treatment option compared with other treatments.

Costs associated with angiogenesis inhibitor therapies for metastatic renal cell carcinoma in clinical practice: results from a medical chart review study

OBJECTIVE

To estimate costs for treatment of mRCC patients receiving angiogenesis inhibitors (AI) using resource utilization data from medical charts.

MATERIALS AND METHODS

A retrospective chart review was performed in two U.S. tertiary oncology centers. Non-trial mRCC patients treated from 04/2003 to 06/2008, ≥ 18 years old, and with ≥ 1 prescription for sunitinib (SU; n = 57), sorafenib (SOR; n = 62), or ≥ 1 intravenous (i.v.) administration bevacizumab (BEV; n = 25) as first AI were included. Per-patient-per-month (PPPM) costs ($2008) were estimated for drug, i.v. administration, office visits, procedures, and AE treatments. AI drug costs were estimated by applying Average Wholesale Price to treatment course. Office visit and procedure costs were based on private insurance reimbursement. Hospitalization costs were based on HCUP National Inpatient Sample charges for AEs and were converted to costs. ER visit cost was based on national average from Medical Expenditure Panel Survey.

RESULTS

Median treatment duration (mo) was 10.5 (SU), 8.1 (SOR), 7.9 (BEV). Average daily oral dosage was 32 mg (SU), 690 mg (SOR); average dose per i.v. administration was 871 mg (BEV). Total PPPM costs were $7,945 (SU), $6,990 (SOR), $15,189 (BEV). AI drugs accounted for the majority of PPPM costs ($5,639 [SU], $5,214 [SOR], $13,664 [BEV]), followed by procedures ($1,420 [SU], $1,004 [SOR], $749 [BEV]), and AE treatments ($729 [SU], $636 [SOR], $291 [BEV]).

CONCLUSIONS

BEV patients incurred about twice the cost of SU patients and more than twice the cost of SOR patients, mainly due to higher drug and i.v. administration costs. Patients who received SU incurred the highest cost for AE management.

Sunitinib (SUTENT) for the treatment of metastatic renal cell carcinoma

Kidney cancer accounts for approximately 2% of new cancers and conventional treatment with nephrectomy followed by IL-2 or IFN-alpha treatment does not provide long-term survival benefit in many patients. Increased understanding of the pathophysiology of renal cell carcinoma has prompted the development of targeted therapies for patients with this disease, including sunitinib. This paper reviews the most recent efficacy and safety data for sunitinib, as well as currently ongoing and planned studies for this receptor tyrosine kinase inhibitor. Results from a large-scale, long-term, Phase III trial have established sunitinib as the standard of care for first-line treatment of patients with advanced renal cell carcinoma, and it is now the reference standard against which other therapies for this cancer should be evaluated.