P-213 - The cost of survival gain in metastatic colorectal cancer (mCRC) in Spain

Date 04 July 2015
Event WorldGI 2015
Session Posters
Topics Bioethics, Legal, and Economic Issues
Colon Cancer
Rectal Cancer
Presenter C. Ngai
Citation Annals of Oncology (2015) 26 (suppl_4): 1-100. 10.1093/annonc/mdv233
Authors C. Ngai1, J. Whalen2, J. Chang1, I. Ozer-Stillman2, A. Ambavane2
  • 1Whippany/US
  • 2Evidera, London/UK



Cost-benefit analyses have been used to evaluate new targeted therapies for cancer, often relying on complex models and extrapolation of overall survival beyond clinical trial follow-up. This exploratory analysis conducts a basic cost-benefit analysis of targeted therapies in mCRC, using a Spanish perspective, based on observed survival in clinical trials.


A literature review was conducted of product information for targeted therapies, identifying phase 3 trials that demonstrated statistically significant median OS (mOS) improvement. Treatment duration was not consistently reported, so median progression-free survival (mPFS) was used as a proxy. The cost of each line (L) was compared with respect to incremental mOS gained. Drug costs were based on the public price including VAT from the Consejo General de Colegios Oficiales de Farmaceuticos (Portalfarma) with a 7.5% discount on brand drugs. Body surface area and weight were based on a study of mCRC patients in the UK, and the calculations assumed 100% dose intensity without vial sharing. The total cost for infused therapies includes the cost of wasted drug. Dose and dosing frequency were based on the regimens included in the clinical trials. Administration costs were based on the average chemotherapy administration cost in nine regional bulletins.


In first line, targeted agents were associated with 3.5 to 4.7 months of mOS gain with an additional cost of 8,044 to 16,370€ per month of mOS gained. In second line, the 1.4 to 2.1 months of mOS gained cost an additional 13,535 to 21,999€ per month of mOS gained. In third line, the cost per month of mOS gained was lowest, ranging from 4,364 to 4,958€, with mOS gains of 1.4 to 4.7 months.


This exploratory analysis indicates that the least cost-effective mCRC treatments are in 2L, and the most cost-effective treatments are in 3L, when measuring benefit as the cost per month of observed mOS gain. This approach should contribute to the ongoing debate over the value of innovation in oncology, particularly with therapies in later lines of treatment. The impact of this analysis on the management of targeted agents in Spain should be explored further, and future analyses should consider other tumor types.

Table: P-213