Cost-effectiveness Analysis of Axtinib in the Treatment of Metastatical Renall Cell Carcinoma - Clinical Data vs RWE

Autoři: Karbusická M., Losenický L., Mazan P., Dolečková J., Duba J., Kolek M.
OBJECTIVES: The aim was to compare costs and effectiveness of axitinib against everolimus in the treatment of metastatic renal cell carcinoma (mRCC) in sunitinib refractory patients from the perspective of the public healthcare payer in the Czech Republic. METHODS: A Markov model was developed to estimate the incremental cost per incremental qualityadjusted life year (QALY) gained of axitinib compared to everolimus in the treatment of mRCC in sunitinib refractory patients over a 10year time horizon. Progressionfree survival (PFS) and overall survival (OS) were selected as basic parameters of effectiveness. PFS and OS were calculated using parametric survival distributions estimated from KaplanMeier curves. As no headtohead trials comparing axitinib and everolimus in treatment of mRCC in sunitinib refractory patients were found, three different approaches are shown: a naive approach comparing data from AXIS and RECORD trials, matchingadjusted indirect comparison (MAIC) comparing real world data for axitinib from Czech registry and clinical trial data for everolimus (RECORD trial) and Simulated Treatment Comparison of AXIS and RECORD trials. Among relevant costs (reflecting payer’s perspective) drug costs, monitoring costs and cost of adverse events were considered. RESULTS: In the naive comparison scenario axitinib is dominant compared to everolimus as it is less costly and generates more QALY. When using Czech real world evidence (RWE) and RECORD trial the incremental costeffectiveness ratio (ICER) of axitinib reached 24,089.71 EUR per QALY gained. The last scenario (STC of AXIS and RECORD) the ICER was 23,000.43 EUR. All of the three scenarios scored way under the level of Czech willingness to pay (WTP) 43,584.06 EUR. CONCLUSIONS: Axitinib proved efficacy in the real clinical practice in the Czech Republic. The costeffectiveness analysis also showed that axitinib can be considered a costeffective treatment for mRCC sunitinib refractory patients when compared to everolimus.
ISPOR 19th Annual European Congress, 29 October - 2 November 2016, Austria Center Vienna, Austria.