Costo-Efficacia di cabozantinib nel trattamento di prima linea del tumore a cellule renali avanzato (aRCC) in Italia Cabozantinib for first-line treatment of advanced renal cell carcinoma (aRCC) in Italy: a cost-effectiveness analysis

Introduction: Clear cell Renal Cell Carcinoma (RCC), par- ticularly when diagnosed at an advanced stage (aRCC), is associated with poor prognosis. The Italian Medical Oncol- ogy Association strongly recommends cabozantinib, su- nitinib and pazopanib for rst line of therapy. The aim of this study was to compare the cost-effectiveness of cabozan- tinib with sunitinib and pazopanib for treatment of adult pa- tients with aRCC as rst line therapy in Italy. Methods: A partitioned, three-state (progression-free, post-progression, death) survival model with a 20-year time horizon was used to estimate the proportion of patients in each state and the total costs associated with each treatment. Ef cacy outcomes were retrieved from a recently published meta-analysis; model inputs included overall survival, pro- gression free survival, time to treatment discontinuation and treatment-emergent adverse events. Utility values were based on published studies. Prices were based on published Italian hospital tenders and NHS Reference Costs. Results: Treatment with cabozantinib appears to be more costly and more effective than both sunitinib and pazopanib. In the reference case, treatment with cabozantinib results in an incremental +0.594 quality-adjusted life years (QALY), with an incremental cost-effectiveness ratio (ICER) of 29,126 €/QALY vs sunitinib and +0.608 QALY with ICER 30,794 €/QALY vs pazopanib. Results were con rmed by univariate and probabilistic sensitivity analyses. Conclusion: Cabozantinib represents a cost-effective op- tion in rst line treatment of aRCC in Italy.