Türkiye’de İleri Evre Böbrek Kanserinde Pazopanib ve Sunitinib Tedavilerinin Maliyet Etkililik Analizi

Abstract

Renal cell carcinoma (RCC) is the most common type of kidney cancer worldwide, focusing on the importance of treatment approaches in effective management of the disease. Studies in the literature reveal that pazopanib (PB) and sunitinib (SB) therapies are standard of care treatments for RCC patients. It has become clear that economic assessment research of PB and SB methods in treatment of advanced kidney cancer has not been conducted in Turkey in response to the presence of studies addressing the economic assessment of these treatments for RCC patients in foreign literature. The aim of the study is to do the economic assessment study of PB and SB methods in the first-line treatment of advanced kidney cancer in Turkey from the perspective of the payer institution. The study included 53 adult patients who were diagnosed with RCC and received one of the PB or SB treatments. The research used a disease/decision model consisting of progression-free survival, progression survival and mortality status. The transition possibilities used to model transitions between health conditions were provided through literature, and simulations were completed in two phases based on different transition probabilities. Markov model and Monte Carlo methods were utilised in the simulation process, and the Monte Carlo simulation method was considered within different theoretical distributions. Resource usage data on RCC disease was provided using the relevant hospital's information system to determine the cost burden on the payer institution. Information on how long patients received chemotherapy treatment was obtained through patient files. Patients were reached using EQ-5D quality-of-life tool for effectiveness measurement, with coefficients of Germany and England based on average quality-adjusted life year (QALY) per patient. A 3% reduction rate was applied in the economic assessment process to consider the time value of cost and health outcomes. The average monthly cost for patients in the case of progression-free survival in the treatment of PB was 10,088.89 TL, compared to 11,351.35 TL for patients in the state of progression survival. The average monthly cost for patients in progression-free survival status for SB treatment was 10,240.73 TL and for patients in progression survival status it was 11,272.20 TL. The average QALY for patients in progression-free survival status for PB treatment was 0.86, compared to 0.42 for patients in progression. The average QALY value for SB treatment was 0.70 for patients without progression and 0.45 for patients with progression. First cost-effectiveness analysis findings suggest that PB therapy is not cost-effective; the findings of cost-effectiveness analysis produced using different transition possibilities revealed that PB therapy for chi-square and poisson distributions was cost-effective. As a result, whether the PB treatment method in first-line treatment of advanced renal cancer disease is cost-effective relative to the SB treatment method varies according to simulation method, transition possibilities, and probability distribution. Further economic assessment are needed to assess which method is cost-effective in RCC treatment.