Cost-effectiveness evaluation of sunitinib as first-line targeted therapy for metastatic renal cell carcinoma in Spain.

INTRODUCTION Sunitinib, an oral, multitargeted receptor tyrosine kinase inhibitor, delays disease progression, with a median overall survival (OS) of more than 2 years, improves quality of life and is becoming the first-line standard of care for metastatic renal carcinoma (mRCC). PURPOSE To assess the economic value of sunitinib as fi rst-line therapy in mRCC within the Spanish healthcare system. METHODS An adapted Markov model with a 10-year time horizon was used to analyse the cost effectiveness of sunitinib vs. sorafenib (SFN) and bevacizumab/interferon-α (BEV/IFN) as first-line mRCC therapy from the Spanish third-party payer perspective. Progression-free survival (PFS) and OS data from sunitinib, SFN and BEV/IFN pivotal trials were extrapolated to project survival and costs in 6-week cycles. Results, in progression-free life-years (PFLY), life years (LY) and quality-adjusted life-years (QALY) gained, expressed as incremental cost-effectiveness ratios (ICER) with costs and benefits discounted annually at 3%, were obtained using deterministic and probabilistic analyses. RESULTS Sunitinib was more effective and less costly than both SFN (gains of 0.52 PFLY, 0.16 LY, 0.17 QALY) and BEV/IFN (gains of 0.19 PFLY, 0.23 LY, 0.16 QALY) with average cost savings/patients of €1,124 and €23,218, respectively. Using a willingness-to-pay (WTP) threshold of €50,000/QALY, sunitinib achieved an incremental net benefit (INB) of €9,717 and €31,211 compared with SFN and BEV/IFN, respectively. At this WTP, the probability of sunitinib providing the highest INB was 75%. CONCLUSION Our analysis suggests that sunitinib is a costeffective alternative to other targeted therapies as first-line mRCC therapy in the Spanish healthcare setting.

[Omega-3-fatty acids: their value in nutrition and prevention]. / Omega-3-Fettsäuren: ihr Stellenwert in Ernährung und Prävention.

Based on epidemiological, experimental and physiological evidence, this review examines whether omega-3 fatty acids (omega-3-PUFA) are cardioprotective and whether they are therefore relevant to the primary prevention of cardiovascular diseases. The high intake of omega-3-PUFA among Greenlandic Eskimos has been supposed to be a key factor for their low mortality rate of coronary heart disease (CHD). Other ecological studies from Norway and Japan suggest that higher fish consumption might be cardioprotective. Three cohort studies have shown an unequivocal inverse relation between fish-intake and CHD mortality, while two others--possibly for methodological reasons--have not shown clear overall associations. Several biological effects of omega-3-PUFA are known which may moderate and influence positively the pathogenesis of atherosclerosis. However, double-blind trials with clinical endpoints are not yet available to confirm these effects. For the time being, fish oil capsules should not be recommended as cardioprotective dietary supplementation, because some uncertainty about their long-term safety and dosage remains. Fish consumption is safe and modifies the FA-pattern of the diet favourably. From the point of view of prevention, rising fish intake up to twice or three times weekly can therefore be recommended for people residing in Switzerland.