604P_PR - The cost of survival gains in metastatic colorectal cancer (mCRC) in four European countries

Date 29 September 2014
Event ESMO 2014
Session Poster Display session
Topics Bioethics, Legal, and Economic Issues
Colon and Rectal Cancer
Presenter Ipek Ozer-Stillman
Citation Annals of Oncology (2014) 25 (5): 1-41. 10.1093/annonc/mdu438
Authors I. Ozer-Stillman1, J. Whalen2, A. Ambavane2, G. Pietsch3, C. Ngai4, A. Mohamed4, J. Chang4
  • 1Health Economics, Evidera, 02420 - Lexington/US
  • 2Health Economics, Evidera, W68DL - London/GB
  • 3Global Pricing, Bayer Healthcare Pharmaceuticals, Inc., Berlin/DE
  • 4Gheor, Specialty Medicine, Bayer Healthcare Pharmaceuticals, Inc., Whippany/US



Innovative therapies for mCRC prolong life when added to conventional chemotherapies, but also increase the cost.


Drug acquisition costs for standard oxaliplatin- and irinotecan-based chemotherapies and innovative therapies (VEGF and EGFR inhibitors) were collected from publicly available sources for France, Germany, Spain, and Italy. Published trials were reviewed to collect the median progression-free survival (mPFS) and overall survival (mOS) for chemotherapies with add-on innovative therapies. Studies were included if add-on therapy demonstrated statistically significant mOS benefit. Treatment duration was not consistently reported for all trials, so mPFS was used as a proxy. The cost of drug regimens for 1st, 2nd, and 3rd therapy lines were calculated and compared with respect to incremental mOS benefits.


In 1st line, adding innovative therapy extended mOS an average of 4.1 months for an average additional cost of 35,600 to 59,900 € per patient across the four countries. Average 2nd-line improvement in mOS was 1.6 months, with additional costs of 19,400 to 31,100 €. Average 3rd-line mOS improvement was 4.7 months, with additional costs of 15,500 to 25,300 €.


Based on published trials and drug prices, EU countries pay 3,300 to 19,500 € per month of survival gain with innovative therapies. The additional cost per month is highest in 2nd line; the value of an additional month may vary across lines due to differences in life expectancy.

Regimen Add-on Drug mPFS (months) mOS (months) mOS Increase (months) Additional Cost (€)
IFL Hurwitz 2004 Bevacizumab – 10.6 6.2 20.3 15.6 4.7 26,200 to 42,300
FOLFIRI Van Cutsem 2011 Cetuximab – 9.9 8.4 23.5 20.0 3.5 40,000 to 67,800
FOLFOX4 Douillard 2014 Panitumumab – 10.0 8.6 23.9 19.7 4.2 38,700 to 69,600
FOLFOX4 Giantonio 2007 Bevacizumab – 7.3 4.7 12.9 10.8 2.1 33,500 to 55,100
Oxaliplatin- or irinotecan- based chemo Bennouna 2012 Bevacizumab – 5.7 4.1 11.2 9.8 1.4 13,600 to 24,700
FOLFIRI Van Cutsem 2012 Aflibercept – 6.90 4.67 13.50 12.06 1.4 19,900 to 29,800
BSC Karapetis 2008 Cetuximab * – 3.7 1.9 9.5 4.8 4.7 15,500 to 25,300

* efficacy based on a retrospective analysis of Phase 3 trial data, in which tumor samples were not available for all randomized patients.


I. Ozer-Stillman, J. Whalen and A. Ambavane: Employee of Evidera, Inc. which is paid to conduct research by drug manufacturers; G. Pietsch, C. Ngai, A. Mohamed and J. Chang: Employee of Bayer, which manufacturers regorafenib, a targeted therapy for metastatic colorectal cancer.