591P - Cost-utility of systemic anticancer therapy (SACT) with or without metastasectomy including local ablative therapy (LAT) for metastatic colorectal cancer (mCRC) patients

Background

Treatment allocation regarding SACT alone or with curative intent metastasectomy±LAT in suitable patients is preferably performed with repeated multidisciplinary team assessment of resectability, as in the RAXO study (ESMO guidelines 2023). The cost-effectiveness of adding metastasectomy whenever possible has not been investigated in the era of modern treatments and care.

Methods

A Markov model was developed to estimate mean healthcare costs and quality-adjusted life-years (QALY) over lifetime, from mCRC diagnosis to death (including end-of-life treatments). The metastasectomy±LAT±SACT and SACT only patient cohorts, along with model input parameters, as transition probabilities, costs, and health-related quality of life, were identified from the Finnish prospective RAXO study (N=1086) recruiting patients 2012–2018. Probabilistic sensitivity analyses (PSA) were performed with Monte Carlo simulations. The analyses were conducted from the healthcare payer's perspective with multiple willingness-to-pay thresholds using 2023 euros.

Results

In the base-case analysis, the mean lifetime costs (158 643€) for patients having metastasectomy±LAT±SACT reached 5.91 QALYs and 6.57 life years (LY), with a cost per QALY of 26 843€ (Table). The SACT only group had costs of 77 203€, QALY reaching 1.74 QALYs and 1.99 LYs and a cost per QALY of 44 370€. The incremental cost-effectiveness ratio (ICER) was 19 530€/QALY (Table), with caveat of more favourable characteristics in the metastasectomy±LAT group. In the PSA, the metastasectomy±LAT strategy dominated cost-effectivity in willingness-to-pay thresholds over 17 000€/QALY. Table: 591P

3% discount rate used

Conclusions

Metastasectomy±LAT is cost-effective, even in the era of the newest SACT options and should be considered for mCRC patients whenever possible. Sensitivity analyses for differences in characteristics are ongoing.

Clinical trial identification

NCT01531621, EudraCT 2011-003158-24.

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

This investigator-initiated study was supported by Finska Läkaresällskapet (2016, 2018, 2019, 2020, 2021, 2022, 2023), The Finnish Cancer Foundation (2019–2020, 2021, 2022–2023), Relander’s foundation (2020–2022) the Competitive State Research Financing of the Expert Responsibility Area of Tampere, Helsinki, Turku, Kuopio, Oulu, and Satakunta Hospitals (2012, 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023), Tampere University Hospital Fund (Tukisäätiö 2019, 2020, 2023 and OOO-project 2020), Helsinki University Hospital research fund (2019, 2020, 2021, 2022, 2023), and the infrastructure with the database and study nurses partly supported by pharmaceutical companies: Amgen—unrestricted grant (2012–2020, 2024), Eli Lilly and Company (2012–2017), Merck KGaA (2012–2020), Roche Oy (2012–2020), Sanofi (2012–2017), and Servier—unrestricted grant (2016–2023). The funders had no role in the study design, analysis, interpretation of the data or decision to publish.

Disclosure

J. Kontiainen: Financial Interests, Personal, Sponsor/Funding: Novartis; Financial Interests, Personal, Speaker, Consultant, Advisor: Takeda; Financial Interests, Institutional, Funding: Amgen, Roche, Sanofi, Lilly, Merck, Servier. K.I. Lehtomaki: Financial Interests, Personal and Institutional, Invited Speaker: Amgen, Roche, Servier; Financial Interests, Institutional, Funding: Lilly, Merck, Sanofi; Financial Interests, Personal, Invited Speaker: Pfizer, AstraZeneca, Bayer. T.T. Muhonen: Financial Interests, Personal and Institutional, Financially compensated role: Amgen, Merck KGaA; Financial Interests, Institutional, Funding: Eli Lilly, Sanofi, Servier, Roche. E. Heerva: Financial Interests, Institutional, Advisory Board: Amgen, Merck, Eli Lilly, Roche, Sanofi, Servier. A. Algars: Financial Interests, Personal and Institutional, Advisory Board: Amgen, Merck, Roche, Servier, Bayer. R. Ristamaki: Financial Interests, Institutional, Funding: Amgen, Lilly, Merck KgA, Roche Finland, Sanofi, Servier. H. Stedt: Financial Interests, Personal and Institutional, Invited Speaker, congress travel, institutional grant: Amgen; Financial Interests, Personal, Advisory Board: AstraZeneca, BMS, Eisai, MSD; Financial Interests, Personal, Other, congress travel: Bayer, Daiichi Sankyo; Financial Interests, Institutional, Funding: Eli Lilly, Sanofi, Servier; Financial Interests, Personal and Institutional, Advisory Board, congress travel, institutional grant: Merck, Roche; Financial Interests, Personal, Invited Speaker: Pierre Fabre. A. Lamminmäki: Financial Interests, Institutional, Funding: Amgen, AstraZeneca, Eli Lilly, Merck, Roche, Servier, Sanofi. R. Kallio: Financial Interests, Institutional, Funding: Amgen, Eli Lilly, Merck, Roche; Financial Interests, Institutional, Advisory Board: Sanofi, Servier. T. Salminen: Financial Interests, Institutional, Funding: Amgen, Eli Lilly, Merck, Roche, Servier, Sanofi, Bayer, Pfizer; Financial Interests, Personal and Institutional, Advisory Role: AstraZeneca. E. Osterlund: Financial Interests, Personal and Institutional, Invited Speaker, Institutional Research Funding: Amgen; Financial Interests, Personal, Training, Travel expenses: Nordic Drugs; Financial Interests, Institutional, Research Funding: Merck, Roche, Sanofi, Lilly; Financial Interests, Institutional, Research Grant: Servier. S. Aho: Financial Interests, Institutional, Funding: Lilly, Merck, Roche, Sanofi, Amgen; Financial Interests, Institutional, Funding, congress attendance fee: Servier. P. Halonen: Financial Interests, Institutional, Funding: Amgen, Eli Lilly, Merck, Roche, Sanofi, Servier. L. Soveri: Financial Interests, Institutional, Research Funding: Amgen, Eli Lilly, Merck, Roche, Sanofi, Servier. A. Nordin: Financial Interests, Institutional, Research Grant: Amgen, Servier; Financial Interests, Institutional, Research Funding: Roche, Sanofi, Merck, Lilly. A. Uutela: Financial Interests, Institutional, Funding: Amgen, Eli Lilly, Merck KgA, Roche Finland, Sanofi, Servier; Financial Interests, Personal, Invited Speaker: Amgen; Financial Interests, Personal, Speaker, Consultant, Advisor: AstraZeneca. H. Isoniemi: Financial Interests, Institutional, Research Funding: Lilly, Merck, Roche, Sanofi; Financial Interests, Institutional, Research Grant: Amgen, Servier. P.J. Osterlund: Financial Interests, Personal, Advisory Board, Also invitied speaker: Amgen; Financial Interests, Personal, Advisory Board, Also invited speaker: AstraZeneca, MSD, BMS; Financial Interests, Personal, Advisory Board, Also invited lecturer: Bayer, Pierre Fabre; Financial Interests, Personal, Invited Speaker: Eisai, Fresenius Kabi, Imedex; Financial Interests, Personal, Advisory Board: Merck, Sanofi, Incyte, Daiichi Sankyo, AstraZeneca, Eisai, Janssen Pharmaceutica; Financial Interests, Personal, Invited Speaker, Roche Finland and Sweden: Roche; Financial Interests, Personal, Invited Speaker, No compensation for advisory boards: Servier; Financial Interests, Personal, Invited Speaker, Also via Medicom: Nordic Drugs/Group; Financial Interests, Personal, Advisory Board, FIMEA expert testimony: BMS; Financial Interests, Personal, Invited Speaker, Nordic guidelines committee.: Danone; Financial Interests, Institutional, Research Grant: Amgen, Servier, Nordic Drugs/Group; Financial Interests, Institutional, Local PI: Incyte; Financial Interests, Institutional, Coordinating PI: Roche, Pfizer; Non-Financial Interests, member: Colores Patient Advocacy Group; Non-Financial Interests, Member, Board member: Finnish cancer society. All other authors have declared no conflicts of interest.