602P - Comparative budget impact analysis of treatment sequences in metastatic colorectal cancer (mCRC): from first (1st) line to third (3rd) line therapies

Date 01 October 2012
Event ESMO Congress 2012
Session Poster presentation III
Topics Bioethics, Legal, and Economic Issues
Colon and Rectal Cancer
Presenter Jean A. Maroun
Authors J.A. Maroun1, T. Boucher2, K. Alloul3
  • 1Medical Oncology, The Ottawa Hospital Regional Cancer Centre, K1H 8L6 - Ottawa/CA
  • 2Evidence Value And Access, Sanofi Canada, Montréal/CA
  • 3Sanofi Canada, Montreal/CA



In the context of personalized cancer care, patients (pts) should receive the therapy that best meets their needs while optimizing the use of healthcare resources. A budget impact model was developed to compare each of the most commonly used mCRC treatment sequences – from 1st line to 3rd line in a Canadian context.


This Excel based model considers the price of each agent, the number of cycles per treatment course, the relative dose intensity of the regimens to determine the cost of the most commonly used mCRC therapies and calculates the costs per overall sequence from 1st line to 3rd line. It takes into account the percentage of pts who benefit from a R0 resection post 1st line chemotherapy and who forego subsequent treatments. Factors such as different percentage use of 1st line FOLFOX vs FOLFIRI and pts' volumes per line of therapy are considered in this model. Users can choose the scenarios they would like to examine. Key variables can be extracted through expert opinion, the literature or, to assess real-world local practices, through chart reviews.


As scenarios considered, the budgetary impact of the 1st line use of FOLFOX or FOLFIRI both given with bevacizumab (bev) on 1st to 3rd line therapy costs was assessed. The relative use of FOLFOX and FOLFIRI with bev was varied from 80% use of FOLFOX and 20% use of FOLFIRI to the opposite. As key variables, the model compares, as 1st line therapy, 18 cycles of FOLFIRI and bev to 8 cycles of mFOLFOX6 followed by 10 cycles of 5FU/LV given with 18 cycles of bev. Also 80% of 1st line pts receive a second line chemotherapy. Assuming a cohort of a 100 pts, when FOLFOX's 1st line use varies from 80% to 20%, the budget varies from $4.14M to $3.85M, with all pts undergoing a R0 resection varying from 11.8 to 8.2 pts.


Focusing on drug costs only, this dynamic and flexible model goes beyond the comparison of upfront 1st line mCRC costs and considers cascading costs on subsequent lines (2nd and 3rd line) and consequences. It can be used to assess variability in local and provincial practice patterns and their impact on overall budget costs and number of pts benefiting from a R0 resection.


J.A. Maroun: Advisory board member for Roche and Sanofi. Involved in research projects with Roche and Sanofi.

T. Boucher: Employee of Sanofi.

K. Alloul: Employee of Sanofi Canada Inc.