Real-world cost-effectiveness of targeted therapy in metastatic renal cell carcinoma in Sweden: a population-based retrospective analysis
Received 26 September 2018
Accepted for publication 31 December 2018
Published 8 February 2019 Volume 2019:11 Pages 1289—1297
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 2
Editor who approved publication: Dr Antonella D'Anneo
Josefine Redig,1 Johan Dalén,1 Ulrika Harmenberg,2 Magnus Lindskog,3 Börje Ljungberg,4 Sven Lundstam,5 Rickard Sandin,6 Thomas Wahlgren,6 Örjan Åkerborg,1 Maria Jakobsson6
1ICON, Stockholm, Sweden; 2Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden; 3Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden; 4Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden; 5Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden; 6Pfizer AB, Sollentuna, Sweden
Objective: To explore cost-effectiveness of targeted therapies (TTs) in the treatment of metastatic renal cell carcinoma (mRCC) in a real-world context using a nationwide population-based approach.
Methods: Data on patients diagnosed with mRCC between 2002 and 2012 were extracted from Swedish national health data registers. To facilitate comparisons of patients diagnosed before and after TT introduction to the market, three cohorts were derived: pre-TT introduction (preTT), patients diagnosed 2002–2005; early TT introduction (TTi), patients diagnosed 2006–2008; and late TT introduction (TTii), which was limited to patients diagnosed 2009–2010 to ensure availability of total health care resource utilization (HCRU) data. Patients were followed until end of 2012. The value of TTs across cohorts was estimated using mean HCRU costs per life-year (LY) gained. Data on HCRU were obtained through national health registers for dispensed medication and inpatient and outpatient care, and the associated costs were estimated using the Lin method to account for censoring. LYs gained were defined as the difference in mean survival over the study period.
Results: The preTT, TTi, and TTii cohorts consisted of 1,366, 1,158, and 806 patients, respectively. Mean survival in years from mRCC diagnosis was 1.45 in the preTT cohort, 1.62 in the TTi cohort, and 1.83 in the TTii cohort. The respective mean total HCRU cost per patient over the study period was US$16,894, US$29,922, and US$30,037. The cost per LY gained per cohort was US$78,656 for TTi vs preTT, US$34,132 for TTii vs preTT, and US$523 for TTii vs TTi.
Conclusion: Given common willingness-to-pay per LY gained thresholds, this study in a real-world population suggests the use of TTs in the Swedish mRCC population is increasingly cost-effective over time.
Keywords: metastatic renal cell carcinoma, targeted therapy, cost-effectiveness, Sweden
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