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Capecitabine/oxaliplatin (XELOX) versus XELOX plus bevacizumab (XELOX + bev) cost-effectiveness for metastatic colorectal cancer (mCRC) in first line treatment: a Brazilian public hospital analysis

Date

09 Oct 2016

Session

Poster display

Presenters

Fernanda Peria

Citation

Annals of Oncology (2016) 27 (6): 474-482. 10.1093/annonc/mdw387

Authors

F.M. Peria1, A.Q. Ungari2, F.N. Dos Santos2, T. Lins-Almeida3, A.A. Nunes1

Author affiliations

  • 1 Internal Medicine Division Of Oncology, HCRP Hospital das Clinicas Faculdade Medicina Universidade de Sao Paulo, 14048-900 - Ribeirao Preto/BR
  • 2 Internal Medicine Division Of Oncology, HCRP Hospital das Clinicas Faculdade Medicina Universidade de Sao Paulo, 14010170 - Ribeirao Preto/BR
  • 3 Internal Medicine, HCRP Hospital das Clinicas Faculdade Medicina Universidade de Sao Paulo, 14048-900 - Ribeirao Preto/BR
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Background

In the last decade there has been a significant improvement in response rates, progression-free survival and overall survival in metastatic colorectal cancer, a result of the development of new standard chemotherapy combinations and appearance of target-specific drugs, such as bevacizumab. Given the high cost of this therapy and since the resources available for health care are increasingly limited, this study aimed to carry out a cost-effectiveness analysis of XELOX protocol plus bevacizumab in first line treatment for patients with metastatic colorectal cancer from the perspective of a public hospital focused on care and education.

Methods

The economic assessment employed a simple decision associated with Markov model, where costs are expressed in local currency (R$) and outcomes in months of life gained (MVG). This model used the TreeAge Pro 2013® software. It has crafted a model of Markov state transition in time horizon of 60 months, each model cycle corresponded to three months. The cost data were collected retrospectively by micro-costing, and obtained through the internal electronic data system of Clinical Oncology Division.

Results

The data effectiveness and the transition probabilities between the states health were calculated using data from clinical studies selected by systematic review. The difference improvement in months of life gained was 2.25 for an extra cost of R$ 47,833.57, which resulted in an increased cost-effectiveness ratio of R$ 21,231.43 per month gain life. In the sensitivity analysis, the variable that had the greatest impact was the effectiveness for clinical support health in XELOX. When this parameter was inserted in the model with the minimum value, the cost-effectiveness ratio increased R$ 7,814.47 and based on the maximum value that was for R$-29,614.12, meaning that in this scenario the XELOX + Bev has become dominated by XELOX.

Conclusions

Considering the World Health Organization cost-effectiveness threshold (three times the value of GDP per capita), the XELOX + bev protocol it was not considered cost-effective.

Clinical trial identification

This study was approved by the Research Ethics Committee of HCFMRP- USP identified as No. 956/2013.

Legal entity responsible for the study

Ribeirao Preto Medical School - University of Sao Paulo

Funding

Ribeirao Preto Medical School - University of Sao Paulo

Disclosure

All authors have declared no conflicts of interest.

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