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Cost-effectiveness analysis of sunitinib in patients with metastatic and/or unresectable gastrointestinal stroma tumours (GIST) after progression or intolerance with imatinib

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Abstract

Introduction

Sunitinib is a multiselective oral inhibitor of several tyrosine-kinase receptors that has demonstrated its efficacy in patients with metastatic and/or unresectable gastrointestinal stroma tumours (GIST) who were resistant to or intolerant to previous treatment with imatinib. The purpose of this study is to assess the cost-effectiveness of sunitinib vs. best supportive care (BSC) in GIST as a second-line treatment, from the perspective of the Spanish National Health System.

Materials and methods

A Markov model was used to assess the cost effectiveness of sunitinib (50 mg/day, 4 weeks “on” and 2 weeks “off”) vs. BSC in GIST as a second-line treatment. Transition probabilities between the three health states considered in the model (progression-free survival (PFS), progression and death) were obtained from a clinical trial [Demetri et al. (2006) Lancet 368:1329–1338]. Health resource data (drugs, medical visits, laboratory and radiology tests, palliative care and adverse events) were obtained from an expert panel. Deterministic and probabilistic sensitivity analyses were conducted.

Results

Projected PFS years, life years (LY) and quality of life adjusted years (QALYs) were higher for sunitinib compared with BSC: 0.50 vs. 0.24, 1.59 vs. 0.88 and 1.00 vs. 0.55. Mean costs per patient were €23,259 with sunitinib and €1,622 with BSC. The incremental cost-effectiveness ratios (ICERs) obtained were: €4,090/month PFS, €30,242/LY and €49,090/QALY gained. The most influential variables for the results were the efficacy and unit cost of sunitinib.

Conclusions

According to the efficiency thresholds for oncology patients in developed countries, sunitinib is considered cost-effective vs. BSC with acceptable costs per LY and QALY gained.

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Authors and Affiliations

  1. Oncology Department, Hospital 12 de Octubre, Madrid, Spain

    Luis Paz-Ares

  2. Oncology Department, Instituto Catalán de Oncología, Barcelona, Spain

    Xavier García del Muro

  3. Oncology Department, Medical Unit, Pfizer España, Madrid, Spain

    Enrique Grande

  4. Health Outcome Research, Medical Unit, Pfizer España, Av. de Europa, 20-B, ES-28108, Alcobendas, Madrid, Spain

    Paloma González & Silvia Díaz

  5. Oblikue Consulting, Barcelona, Spain

    Max Brosa

Authors
  1. Luis Paz-Ares
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  2. Xavier García del Muro
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  3. Enrique Grande
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  4. Paloma González
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  5. Max Brosa
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  6. Silvia Díaz
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Correspondence to Silvia Díaz.

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Currently not working at Pfizer Spain

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Paz-Ares, L., García del Muro, X., Grande, E. et al. Cost-effectiveness analysis of sunitinib in patients with metastatic and/or unresectable gastrointestinal stroma tumours (GIST) after progression or intolerance with imatinib. Clin Transl Oncol 10, 831–839 (2008). https://doi.org/10.1007/s12094-008-0297-3

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  • DOI: https://doi.org/10.1007/s12094-008-0297-3

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