{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T16:18:15Z","timestamp":1789402695105,"version":"build-2803163510"},"reference-count":46,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"9","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Global Oncology"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:sec>\n                    <jats:title>PURPOSE<\/jats:title>\n                    <jats:p>Tyrosine kinase inhibitors such as sunitinib and pazopanib are the mainstay of treatment of metastatic renal cell carcinoma (mRCC) in India. However, pembrolizumab and nivolumab have shown significant improvement in the median progression-free survival and overall survival among patients with mRCC. In this study, we aimed to determine the cost-effectiveness of the first-line treatment options for the patients with mRCC in India.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A Markov state-transition model was used to measure the lifetime costs and health outcomes associated with sunitinib, pazopanib, pembrolizumab\/lenvatinib, and nivolumab\/ipilimumab among patients with first-line mRCC. Incremental cost per quality-adjusted life-year (QALY) gained with a given treatment option was compared against the next best alternative and assessed for cost-effectiveness using a willingness to pay threshold of one-time per capita gross-domestic product of India. The parameter uncertainty was analyzed using the probabilistic sensitivity analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>We estimated the total lifetime cost per patient of \u20b9 0.27 million ($3,706 US dollars [USD]), \u20b9 0.35 million ($4,716 USD), \u20b9 9.7 million ($131,858 USD), and \u20b9 6.7 million ($90,481 USD) for the sunitinib, pazopanib, pembrolizumab\/lenvatinib, and nivolumab\/ipilimumab arms, respectively. Similarly, the mean QALYs lived per patient were 1.91, 1.86, 2.75, and 1.97, respectively. Sunitinib incurs an average cost of \u20b9 143,269 ($1,939 USD) per QALY lived. Therefore, sunitinib at current reimbursement rates (\u20b9 10,000 per cycle) has a 94.6% probability of being cost-effective at a willingness to pay threshold of 1-time per capita gross-domestic product (\u20b9 168,300) in the Indian context.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Our findings support the current inclusion of sunitinib under India's publicly financed health insurance scheme.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/go.22.00246","type":"journal-article","created":{"date-parts":[[2023,2,16]],"date-time":"2023-02-16T15:59:17Z","timestamp":1676563157000},"update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":14,"title":["Cost-Effectiveness of the First Line Treatment Options For Metastatic Renal Cell Carcinoma in India"],"prefix":"10.1200","author":[{"given":"Dharna","family":"Gupta","sequence":"first","affiliation":[{"name":"Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0981-4751","authenticated-orcid":false,"given":"Ashish","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4079-2631","authenticated-orcid":false,"given":"Nidhi","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4605-7470","authenticated-orcid":false,"given":"Nikita","family":"Mehra","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Adyar Cancer Institute, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9952-6077","authenticated-orcid":false,"given":"Pankaj","family":"Bahuguna","sequence":"additional","affiliation":[{"name":"Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India"},{"name":"School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vipul","family":"Aggarwal","sequence":"additional","affiliation":[{"name":"National Health Authority, Ayushman Bharat PM-JAY, Government of India, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9187-842X","authenticated-orcid":false,"given":"Manjunath Nookala","family":"Krishnamurthy","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology, Tata Memorial Centre, Mumbai, Maharashtra, India"},{"name":"Homi Bhabha National Institute, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Partha Sarathi","family":"Roy","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Dr B. 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