Health Care Costs Among Renal Cancer Patients Using Pazopanib and Sunitinib Response

BACKGROUND: Pazopanib was noninferior to sunitinib in progression-free survival in a phase III, open-label, randomized clinical trial comparing the efficacy and safety of the 2 drugs for treatment of patients with advanced renal cell carcinoma (RCC). A secondary analysis of this trial conducted on patient-reported health care resource utilization (HCRU) endpoints revealed significantly fewer monthly telephone consultations and emergency department visits among patients treated with pazopanib over the first 6 months of treatment. OBJECTIVES: To (a) compare total costs of HCRU and adverse events (AEs) in patients with advanced RCC receiving first-line pazopanib or sunitinib from the phase III clinical trial and (b) perform a post hoc economic analysis that applied direct medical care and pharmacy unit costs, obtained from the Truven Health Market Scan Databases, to HCRU and AE rates. METHODS: Total HCRU costs included components for provider contacts, diagnostics, hospitalizations, procedures, and study/nonstudy drugs. Patients were stratified by the presence or absence of an AE in order to estimate costs attributable to AEs. Costs were adjusted to 2013 U.S. dollars. The highest 1% of cost outliers were equally excluded from each group. Univariate (t-test and Kaplan-Meier sample average [KMSA]) and multivariate (using treatment group and region as covariates) analyses were performed. RESULTS: A total of 906 patients (pazopanib, n=454; sunitinib, n=452) reported HCRU; higher rates were observed for sunitinib. In unadjusted cost analyses, the mean total costs for pazopanib-treated patients were 29.7% lower than those treated with sunitinib ($12,120 vs. $15,727; P=0.017). The difference in KMSA-estimated costs was also significantly higher for sunitinib versus pazopanib ($29,043 vs. $21,026; P=0.006). Adjusted cost differences between arms also remained significant. A cost increase of $1,094 for pazopanib and $2,247 for sunitinib was associated with patients who experienced >= 1 designated AEs. CONCLUSIONS: The findings suggest that health care costs were significantly lower among patients with advanced RCC treated first-line with pazopanib versus sunitinib. Copyright (C) 2015, Academy of Managed Care Pharmacy. All rights reserved.