Cost-Effectiveness of Adding Cetuximab to Platinum-Based Chemotherapy for First-Line Treatment of Recurrent or Metastatic Head and Neck Cancer

Abstract

Purpose To assess the cost effectiveness of adding cetuximab to platinum-based chemotherapy in first-line treatment of patients with recurrent or metastatic head and neck squamous cell carcinoma (HNSCC) from the perspective of the Canadian public healthcare system. Methods We developed a Markov state transition model to project the lifetime clinical and economic consequences of recurrent or metastatic HNSCC. Transition probabilities were derived from a phase III trial of cetuximab in patients with recurrent or metastatic HNSCC. Cost estimates were obtained from London Health Sciences Centre and the Ontario Case Costing Initiative, and expressed in 2011 CAD. A three year time horizon was used. Future costs and health benefits were discounted at 5%. Results In the base case, cetuximab plus platinum-based chemotherapy compared to platinum-based chemotherapy alone led to an increase of 0.093 QALY and an increase in cost of $36,000 per person, resulting in an incremental cost effectiveness ratio (ICER) of $386,000 per QALY gained. The cost effectiveness ratio was most sensitive to the cost per mg of cetuximab and the absolute risk of progression among patients receiving cetuximab. Conclusion The addition of cetuximab to standard platinum-based chemotherapy in first-line treatment of patients with recurrent or metastatic HNSCC has an ICER that exceeds $100,000 per QALY gained. Cetuximab can only be economically attractive in this patient population if the cost of cetuximab is substantially reduced or if future research can identify predictive markers to select patients most likely to benefit from the addition of cetuximab to chemotherapy.

Balancing Safety and Efficacy of Epidermal Growth Factor Receptor Inhibitors in Patients With Squamous Cell Carcinoma of the Head and Neck

“…Cumulatively, these results have been used to support platinum/cetuximab-based www.TheOncologist.com The Oncologist therapy in the first-line treatment of R/M SCCHN in the U.S. and Europe, although some have found the combination too expensive to justify the modest improvement in OS. A formal cost-effectiveness analysis in Canada, for example, suggested that the addition of cetuximab exceeded CAD$100,000 per quality-adjusted life-year gained and thus was felt to be not cost-effective despite the observed OS benefit [69,70]. The combination of EGFRI plus a taxane has been similarly studied.…”

Economic Evaluation of Brentuximab Vedotin for Persistent Hodgkin Lymphoma

“…For example, an economic evaluation of adding bevacizumab to paclitaxel and carboplatin for the treatment of ovarian cancer resulted in an icer of $479,712 per life-year gained 40 . The addition of cetuximab to platinum-based chemotherapy for the first-line treatment of recurrent or metastatic headand-neck cancer resulted in an icer of $386,000 per qaly gained 41 . Bevacizumab in combination with paclitaxel in the first-line treatment of patients with metastatic breast cancer yielded an icer of $745,000 per qaly gained 42 .…”

Time-Series Modeling and Simulation for Comparative Cost-Effective Analysis in Cancer Chemotherapy: An Application to Platinum-Based Regimens for Advanced Non-small Cell Lung Cancer

“…[6][7][8] The objectives of these cost-effective analyses were to compare two or more regimens from the viewpoint of increasing cost per increasing efficacy. From a pharmaceutical viewpoint, in order to choose the optimal regimen that provides the best cost-effective ratio, information regarding both treatments' efficacy and the frequency and severity of possible adverse events (AEs) should be considered when comparing different regimens.…”