Cost-Effectiveness of the First Line Treatment Options For Metastatic Renal Cell Carcinoma in India

Gupta, D. et al. (2023) Cost-Effectiveness of the First Line Treatment Options For Metastatic Renal Cell Carcinoma in India. JCO Global Oncology(9), e2200246. (doi: 10.1200/go.22.00246) (PMID:36795991) (PMCID:PMC10166401)

Abstract

PURPOSE Tyrosine kinase inhibitors such as sunitinib and pazopanib are the mainstay of treatment of metastatic renal cell carcinoma (mRCC) in India. However, pembrolizumab and nivolumab have shown significant improvement in the median progression-free survival and overall survival among patients with mRCC. In this study, we aimed to determine the cost-effectiveness of the first-line treatment options for the patients with mRCC in India. METHODS A Markov state-transition model was used to measure the lifetime costs and health outcomes associated with sunitinib, pazopanib, pembrolizumab/lenvatinib, and nivolumab/ipilimumab among patients with first-line mRCC. Incremental cost per quality-adjusted life-year (QALY) gained with a given treatment option was compared against the next best alternative and assessed for cost-effectiveness using a willingness to pay threshold of one-time per capita gross-domestic product of India. The parameter uncertainty was analyzed using the probabilistic sensitivity analysis. RESULTS We estimated the total lifetime cost per patient of ₹ 0.27 million ($3,706 US dollars [USD]), ₹ 0.35 million ($4,716 USD), ₹ 9.7 million ($131,858 USD), and ₹ 6.7 million ($90,481 USD) for the sunitinib, pazopanib, pembrolizumab/lenvatinib, and nivolumab/ipilimumab arms, respectively. Similarly, the mean QALYs lived per patient were 1.91, 1.86, 2.75, and 1.97, respectively. Sunitinib incurs an average cost of ₹ 143,269 ($1,939 USD) per QALY lived. Therefore, sunitinib at current reimbursement rates (₹ 10,000 per cycle) has a 94.6% probability of being cost-effective at a willingness to pay threshold of 1-time per capita gross-domestic product (₹ 168,300) in the Indian context. CONCLUSION Our findings support the current inclusion of sunitinib under India's publicly financed health insurance scheme.

• Item Type: Articles
• Additional Information: Supported by Department of Health Research, Ministry of Health and Family Welfare, Government of India vide Grant No. F.No.T.11011/02/2017-HR/3100291.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Bahuguna, Dr Pankaj
• Authors: Gupta, D., Singh, A., Gupta, N., Mehra, N., Bahuguna, P., Aggarwal, V., Krishnamurthy, M. N., Roy, P. S., Malhotra, P., Gupta, S., Kumar, L., Kataki, A., and Prinja, S.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment
• Journal Name: JCO Global Oncology
• Publisher: American Society of Clinical Oncology (ASCO)
• ISSN: 2687-8941
• ISSN (Online): 2687-8941
• Copyright Holders: Copyright © 2023 American Society of Clinical Oncology
• First Published: First published in JCO Global Oncology 9:e2200246
• Publisher Policy: Reproduced under a Creative Commons License