P-0252 - Cost-effectiveness of different chemotherapy strategies for patients with advanced colorectal cancer in Brazil: a PublicHealth System perspective

Date 28 June 2014
Event World GI 2014
Session Poster Session
Topics Anti-Cancer Agents & Biologic Therapy
Bioethics, Legal, and Economic Issues
Colon Cancer
Rectal Cancer
Presenter Adriana de Carvalho
Citation Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165
Authors A. de Carvalho, A. Sasse
  • CEVON - Centre for Evidence in Oncology - UNICAMP - State University of Campinas, Campinas/BR



Different chemotherapy combinations, integrating oxaliplatin and irinotecan into 5-fluorouracil-based regimens, and also adding monoclonal antibodies as bevacizumab (bev), cetuximab (cet) and panitumumab (pan) to chemotherapy have been shown to improve overall survival of metastatic colorectal cancer (mCRC) patients. However, the ideal combinations and sequences of these regimens are not well defined. We aimed to assess the cost-effectiveness of existing sequences of treatment using different 1st, 2nd and 3rd line regimens for managing advanced colorectal cancer.


We created a decision analytic model comparing the costs and effects of 14 different treatment strategies for patients with mCRC, all compared to Best Supportive Care (BSC). We use efficacy data from randomized controlled trials found through systematic review and indirect comparison. Incremental costs per life-year (LY) gained with the different sequences were evaluated using a Markov modeling approach. Costs and outcomes were discounted at 5% annually, for a life-time horizon. The analysis adopted the perspective of the Brazilian Public Health System.


The different strategies with respective costs, effectiveness and incremental cost-effectiveness ratio (ICER) are shown in the table.


The incorporation of new chemotherapy regimens consistently improves the expected survival for patients with mCRC in the model. The strategy with longer estimated survival in the model used bevacizumab combined to 1st-line FOLFIRI, followed by continuation of bevacizumab after progression, combined to FOLFOX, and followed by cetuximab combined to irinotecan. The strategy using monoclonal antibodies with most favorable ICER in the model started with FOLFIRI plus cetuximab for KRASwt patients and FOLFIRI plus bevacizumab for KRASmt patients, followed by FOLFOX in 2nd-line.

The addition of any monoclonal antibodies to chemotherapy in patients with mCRC has a cost-effectiveness ratio above the threshold recommended by World Health Organization for incorporation in the countries like Brazil.