594P - Canadian economic analysis of bevacizumab, cetuximab, and panitumumab in the first line treatment of KRAS wild-type metastatic colorectal cancer (mC...
|Date||01 October 2012|
|Event||ESMO Congress 2012|
|Session||Poster presentation III|
|Topics|| Bioethics, Legal, and Economic Issues
D. Lawrence1, M. Maschio2, S. Yunger3, J. Easaw4, N. Aucoin5, M. Weinstein6
CRC is the second leading cause of cancer death in Canada. Bevacizumab, a recombinant humanised monoclonal antibody that selectively binds to human vascular endothelial growth factor, is approved and funded for first line mCRC use in Canada. A substudy has also confirmed its effectiveness in KRAS wild-type patients. Recent evidence has also shown clinical benefit from anti-epidermal growth factor treatments panitumumab and cetuximab in these patients. Objective: We assessed cost-effectiveness of fluoropyrimidine-based chemotherapy (FBC) alone and in combination with bevacizumab, panitumumab or cetuximab for first line treatment of KRAS wild-type mCRC patients.Methods
Cost-effectiveness to the Canadian health care system was estimated using separately reported trial survival and adverse event results for each comparator. We used a Markov model calibrated to progression-free/overall survival, and calculated quality-adjusted life years (QALYs). Health-state resource utilization was derived from published data and Canadian oncologist input. Health state utilities and unit prices were obtained from published literature and standard Canadian sources.Results
Results per patient over a lifetime horizon, to a maximum 10 years with 5% discounting are presented below. Comparators are ordered by total cost, and the incremental cost-effectiveness ratio (ICER) of each is determined against the previous non-dominated therapy.
|Comparator||Total Cost||Total QALYs||Δ Cost||Δ QALYs||ICER|
|Bevacizumab + FBC||$104,054||1.848||$64,993||0.494||$131,631|
|Panitumumab + FBC||$151,776||1.806||$47,722||-0.041||Dominated|
|Cetuximab + FBC||$161,596||1.865||$57,542||0.017||$3,327,501|
For first line treatment of KRAS wild-type mCRC in Canada, bevacizumab + FBC is associated with substantially lower costs than panitumumab + FBC or cetuximab + FBC. All three biologics may be associated with similar QALYs, although; this conclusion was based on the limitation of modelling life expectancy from separate trials. Given these findings, bevacizumab seems likely to offer the best value for money for this patient population.Disclosure
D. Lawrence: Donna Lawrence is an employee of OptumInsight under contract with Roche.
M. Maschio: Michael Maschio is an employee of OptumInsight under contract with Roche.
S. Yunger: Simon Yunger is employee of Roche Canada.
N. Aucoin: Dr. Aucoin has participated in advisory boards with Roche and Amgen.
M. Weinstein: Dr. Weinstein is a consultant to OptumInsight for research under contract with Roche.
All other authors have declared no conflicts of interest.