Costs Of Adverse Events In First-Line Metastatic Renal Cell Carcinoma Treatment: Bevacizumab In Combination With Interferon-a2a Vs Sunitinib

Main Category: Cancer / Oncology
Also Included In: Urology / Nephrology
Article Date: 16 Mar 2010 - 5:00 PDT


UroToday.com - The availability of novel and promising targeted therapies for the treatment of patients with metastatic renal cell carcinoma (RCC), such as bevacizumab plus interferon and sunitinib, has meant important increases in options for patients and physicians treating this deadly disease. It has also meant that patients can take medications, non-curatively, for long periods of time. So an understanding of the treatment-associated side effects with these therapies is very important, as is an understanding of the costs of these treatments. In the current paper, recently published in the British Journal of Cancer, we analysed the secondary costs of treating these side effects that can be associated with bevacizumab plus IFN and sunitinib in the treatment of patients with metastatic RCC. Traditionally, only primary costs such as the pricing of drugs and doctors and/or hospital charges have been assessed.

Taking pivotal trial data for bevacizumab plus IFN[1] and sunitinib[2] in addition to financial figures obtained from the healthcare systems of France, Germany, the UK and Italy, we used a linear decision analytic model to calculate a cost comparison for the two therapies. We found that the average cost per patient for the management of grade 3 and 4 side effects was markedly higher with sunitinib, as compared to bevacizumab plus IFN. Despite a relevant cost variability among the four countries, sunitinib treatment led to an average increase over bevacizumab plus IFN in the costs of treatment per patient, due to the management of these side effects, of 637.5 € (ranging from 418 € for Germany to 972 € for France). This translates to a potential cost saving per patient, of managing all-grade side effects, between 29% - 62%, at 44% in the UK, 29% in Germany and 62% in France; in Italy at 55% per patient.

Of note we found similar findings across each of the countries studied, despite different healthcare systems and baseline costs. All country results were in favour of bevacizumab plus IFN, and may be generalised to other countries. The results are important and confirm that bevacizumab plus IFN is better tolerated than sunitinib, in particular with respect to bothersome side effects such as diarrhoea, nausea, vomiting and the so-called hand and foot syndrome (a painful skin condition). Intuitively, one would expect that a treatment regimen that leads to fewer and less bothersome side effects also requires lower costs to treat these side effects. This study provides scientific evidence for this intuition, with the better tolerability of bevacizumab plus IFN leading to reproducible and important cost savings.

Together with evidence that bevacizumab plus IFN and sunitinib show similar efficacy, the lower costs for treating side effects makes bevacizumab plus IFN an attractive option for first line treatment of RCC. For patients and healthcare payers alike, the cost savings shown in this study with bevacizumab plus IFN are good news because this well tolerated innovative treatment for RCC is clearly associated with a competitive cost saving.

We therefore hope that these data will help doctors and patients in guiding treatment decisions and will provide the payers' communities, e.g. a national healthcare system, with the information that they need to develop a comprehensive understanding of all treatment related costs associated with novel treatment approaches for patients with metastatic RCC.

References:

1. Escudier B, Pluzanska A, Koralewski P, Ravaud A, Bracarda S, Szczylik C, Chevreau C, Filipek M, Melichar B, Bajetta E, Gorbunova V, Bay JO, Bodrogi I, Jagiello-Gruszfeld A and Moore N (2007) AVOREN Trial investigators. Bevacizumab plus interferon alfa-2a for treatment of metastatic renal cell carcinoma: a randomised, double-blind phase III trial. Lancet 370: 2103 - 2111.

2. Motzer RJ, Hutson TE, Tomczak P, Michaelson MD, Bukowski RM, Rixe O, Oudard S, Negrier S, Szczylik C, Kim ST, Chen I, Bycott PW, Baum CM and Figlin RA (2007) Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med 356: 115 - 124.

Written by Gerald Mickisch, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations, etc., of their research by referencing the published abstract.

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