Cost-Effectiveness Analysis of Different Sequences of the Use of Epidermal Growth Factor Receptor Inhibitors for Wild-Type KRAS Unresectable Metastatic Colorectal Cancer.
J Oncol Pract
; 12(6): e710-23, 2016 06.
Article
em En
| MEDLINE
| ID: mdl-27143148
ABSTRACT
PURPOSE:
Patients with unresectable wild-type KRAS metastatic colorectal cancer benefit from fluoropyrimidines (FP), oxaliplatin (O), irinotecan (I), bevacizumab (Bev), and epithelial growth factor receptor inhibitors (EGFRI). The most cost-effective regimen remains unclear.METHODS:
A Markov model was constructed to examine the costs and outcomes of three treatment strategies strategy A (reference strategy) EGFRI monotherapy in third line ([3L]; ie, first-line [1L] Bev + FOLFIRI [FP + I] or FOLFOX [FP + O]; second line [2L] FOLFIRI/FOLFOX; 3L EGFRI); strategy B EGFRI and I in 3L (ie, 1L Bev + FOLFIRI/FOLFOX; 2L FOLFIRI/FOLFOX; 3L EGFRI + I); and strategy C EGFRI in 1L (ie, 1L EGFRI + FOLFIRI/FOLFOX; 2L Bev + FOLFIRI/FOLFOX; 3L best supportive care). Efficacy data of the treatments were obtained from the literature. Health system resource use information was derived from chart review and the literature. Using Euro-QOL 5 Dimensions, utilities were obtained by surveying medical oncologists and costs from the Ontario Ministry of Health and the literature. The perspective of the Canadian public health care system was used over a 5-year time horizon with a 5% discount in 2012 Canadian dollars.RESULTS:
All three strategies had similar efficacy, but strategy C was most expensive. The incremental cost-effectiveness ratios (ICERs) for strategies B and C compared with A were 119,623 and 3,176,591, respectively. The model was primarily driven by the acquisition cost of the drugs. Strategy B was most cost effective when the willingness-to-pay threshold was > $130,000 per quality-adjusted life-year. Sensitivity analysis showed that strategy C would be cost-effective only when the progression-free survival of EGFRI is better than Bev in 1L with hazard ratio < 0.23 at willingness-to-pay of $150,000 per quality-adjusted life-year.CONCLUSION:
First-line use of EGFRI in metastatic colorectal cancer is not cost effective at its current pricing relative to Bev.
Texto completo:
1
Coleções:
01-internacional
Contexto em Saúde:
1_ASSA2030
Base de dados:
MEDLINE
Assunto principal:
Neoplasias Colorretais
/
Receptores ErbB
/
Antineoplásicos
Tipo de estudo:
Clinical_trials
/
Health_economic_evaluation
/
Prognostic_studies
Aspecto:
Patient_preference
Limite:
Humans
Idioma:
En
Revista:
J Oncol Pract
Ano de publicação:
2016
Tipo de documento:
Article