Lower Costs of Pazopanib for Advanced RCC May Influence Drug Choice

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Any new study of pazopanib or sunitinib must be placed in perspective of the changing treatment landscape and the market entrance of new immunotherapies.
Any new study of pazopanib or sunitinib must be placed in perspective of the changing treatment landscape and the market entrance of new immunotherapies.

Treatment for advanced renal cell carcinoma (RCC) with a first targeted therapy of pazopanib resulted in significantly lower health care costs and health resource utilization compared with treatment with sunitinib, according to the results of a real-world economic study published in the Journal of Managed Care & Specialty Pharmacy.1

The study compared costs and use in a population of almost 2000 patients on Medicare who had advanced RCC.

Unfortunately, the field of RCC has changed since this study was conducted, according to first author Nicholas Vogelzang, MD, of the Comprehensive Cancer Centers of Nevada, Las Vegas.

“When I first saw these data I thought, ‘Wow, this is really great! We finally have some clarity on whether, if these drugs are equal, maybe the cheaper drug is the better drug,'” Dr Vogelzang told Cancer Therapy Advisor. “Then, right after we finished the analysis, out came the immuno-oncology story.”

This “story” refers to the presentation and publication of positive results from clinical trials testing immunotherapies such as program death-ligand 1 (PD-L1) and PD-1 inhibitors against sunitinib in patients with advanced RCC.

“There are two studies that have been reported and both have showed superiority over sunitinib,” Dr. Vogelzang said.2,3 “Pazopanib was not a comparator arm so we do not know how pazopanib would have done in such a trial.”

The bottom line is now, Dr. Vogelzang said, many patients are going to get the immuno-oncology drugs as a first-line therapy instead of sunitinib or pazopanib. 

What the Study Found

For the real-world analysis, Dr Vogelzang and colleagues identified 1711 patients from Medicare and Part D databases who had initiated first targeted therapy with sunitinib (n = 1185) or pazopanib (n = 526) between October 2009 and January 2014. These patients were matched 1:1 on baseline characteristics using propensity scores.

Looking at time on treatment, patients treated with pazopanib had lower total all-cause health care costs (mean $8,527 vs $10,924), total medical costs ($3,991 vs $5,881), and inpatients costs  ($2,040 vs $3,731; P < .01 for all) compared with patients treated with sunitinib.

Additionally, patients treated with pazopanib had fewer inpatient admissions (P < .01) and days (P < .01) compared with sunitinib.

Dr Vogelzang noted that this study looked at a more elderly population, a factor that has important implications.

“Any drug that keeps people out of the hospital a bit more may well reduce some out-of-pocket expenses and reduce other issues as well,” he said. “It's an important piece of economic information.”

However, he said it is unlikely to affect treatment decisions very much.

“This paper has more importance for pharmacy managers or insurance companies,” Dr Vogelzang noted. “Don't forget, these drugs will still be used, but more likely after immuno-oncology drugs.”

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