Pazopanib or Sunitinib? cost-utility analysis of pazopanib versus sunitinib in the first-line treatment of metastatic renal cell carcinoma in Jordan

Objectives To evaluate the cost-effectiveness of pazopanib for the treatment of metastatic renal cell carcinoma (mRCC) in the first-line settings from a payer perspective. Methods A state-transition model with three health states was developed to estimate the incremental cost per quality-adjusted life years (QALY) gained for pazopanib compared to sunitinib. A lifelong time horizon was adopted in the base-case analysis. The transition probabilities were estimated based on the COMPRAZ trial, utility weights were taken from literature, and costs were based on estimating medical resource utilization data at King Hussein Cancer Centre (KHCC), deriving unit cost inputs from KHCC databases and the Jordan Food and Drug Administration website. Both costs and outcomes were discounted using 3% rate. The model's uncertainty was tested using a probabilistic and deterministic sensitivity analyses. Key findingsThe base-case results showed that pazopanib was dominant when using the listed price for both medications. Pazopanib was associated with an incremental saving of -$10 721.55 and an incremental QALY of 0.08. The results were sensitive to utility values and the progression health state cost. The probabilistic sensitivity analysis showed that the probability of pazopanib being cost-effective compared to sunitinib is around 60-70% at KHCC cost-effectiveness threshold values. However, the result was reversed when the price of sunitinib was reduced by 40% making sunitinib the dominant strategy. Conclusions Pazopanib is a potential cost-effective option in the first-line settings for mRCC when the listed price of sunitinib is used. Therefore, price negotiations are recommended before final listing decisions to get the most cost-saving treatment.