P-212 - The cost of survival gain in metastatic colorectal cancer (mCRC) in France

Date 04 July 2015
Event WorldGI 2015
Session Posters
Topics Bioethics, Legal, and Economic Issues
Colon and Rectal Cancer
Presenter C. Ngai
Citation Annals of Oncology (2015) 26 (suppl_4): 1-100. 10.1093/annonc/mdv233
Authors C. Ngai1, J. Whalen2, J. Chang1, I. Ozer-Stillman2, A. Ambavane2
  • 1Whippany/US
  • 2Evidera, London/UK



There is a growing concern that new, high-cost cancer treatment does not necessarily translate into improved outcomes. Several techniques have been used to evaluate the incremental cost/benefit of a new cancer treatment including complex modeling such as cost-effectiveness analysis. This analysis explores a simple, direct measure of the value (cost per month of OS gain) using targeted treatments for mCRC and cost data from France.


A targeted literature review was conducted of product information for targeted therapies, identifying phase 3 trials, which demonstrated statistically significant median OS (mOS) improvement. Treatment duration was not consistently reported, so median progression-free survival (mPFS) was used as a proxy. The cost of each line (L), estimated from the public price including VAT from the Securite Sociale l'Assurance Maladie and administration costs from the Agence Technique de L'Information sur L'Hospitalisation, was compared with respect to incremental mOS gained. Body surface area and weight were based on a study of mCRC patients in the UK, and the calculations assumed 100% dose intensity and no vial sharing; the cost of wasted drug was included in the total cost for infused therapies. Dose and dosing frequency were based on the regimens included in the clinical trials.


In first line, targeted agents were associated with 3.5 to 4.7 months of mOS gain with an additional cost of 7,037 to 14,005€ per month of mOS gained. In second line, the 1.4 to 2.1 months of mOS gained cost an additional 11,790 to 18,713€ per month of mOS gained. In third line, the cost per month of mOS gained was lowest, ranging from 3,764 to 4,339€, with mOS gains of 1.4 to 4.7 months.


This exploratory analysis uses a simple, direct measure of value. Using cost per month of OS gain as the metric, the least cost-effective mCRC treatments are in 2L, and the most cost-effective treatments are in 3L. This simple analysis should contribute to the ongoing debate over the value of innovation in oncology, especially in late line. It would be interesting to expand this analysis to other tumors to compare the findings.

Table: P-212