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
Colon and Rectal Cancer
Presenter Donna Lawrence
Authors D. Lawrence1, M. Maschio2, S. Yunger3, J. Easaw4, N. Aucoin5, M. Weinstein6
  • 1Health Economics & Outcomes, Optum Insight, Burlington/CA
  • 2Life Sciences, Optum Insight, Burlington/CA
  • 3Hoffmann La Roche, L5N6L7 - Mississiauga/CA
  • 4Medical Oncology, Tom Baker Cancer Centre, T2N 4N2 - Calgary/CA
  • 5Medical Oncology, Cité-de-la-Santé Hospital, Laval/CA
  • 6Harvard School Of Public Health, Harvard University, 02115 - Boston/US



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.


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 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
FBC $39,061 1.354 - - -
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.


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.