Effectiveness and Costs Associated to Adding Cetuximab or Bevacizumab to Chemotherapy as Initial Treatment in Metastatic Colorectal Cancer: Results from the Observational FABIO Project

Abstract

Evidence available on the effectiveness and costs of biological therapies for the initial treatment of metastatic colorectal cancer (mCRC) is scarce and contrasting. We conducted a population-based cohort investigation for assessing overall survival and costs associated with their use in a real-world setting. Healthcare utilization databases were used to select patients newly diagnosed with mCRC between 2010 and 2016. Those initially treated with biological therapy (bevacizumab or cetuximab) added to chemotherapy were propensity-score-matched to those treated with standard chemotherapy alone, and were followed up to June 30th, 2018. Kaplan–Meier survival estimates, restricted mean survival time (RMST) and cumulative costs were compared between the two treatment arms. The study cohort included 1896 mCRC patients treated with biological therapy matched to 5678 patients treated with chemotherapy alone. Median overall survival was 21.8 and 20.2 months, respectively. After 84 months of follow-up, RMSTs were 30.9 and 31.9 months (p = 0.193), indicating no differences between the average survival time between treatment arms. Patients treated with biological therapy were associated with higher costs. Cumulative per capita costs were €59,663 and €44,399, respectively. In our study, first-line biological therapy did not improve long-term overall survival and was associated with higher costs as compared to standard chemotherapy.

Early combination of albumin with crystalloids administration might be beneficial for the survival of septic patients: a retrospective analysis from MIMIC-IV database

“…The strength of this study was the RMST analysis. RMST was firstly proposed in 2010 and well established in Cardiovascular and Cancer studies as an alternative measure of the intervention effect [25,[39][40][41]. At present, most randomized controlled trials and observational studies in critical care evaluated the intervention effect with the increment or reduction of risk utilizing hazard ratio (HR) and its 95% CI [39].…”

Bortezomib-based therapy in non-transplant multiple myeloma patients: a retrospective cohort study from the FABIO project

“…Details of regional HCU databases of Italy and of the FABIO network have been previously reported. 9 Specific diagnostic and therapeutic codes used for this study are reported in Supplementary material ( Table S1 ).…”

“…Information on the number of patients still alive at each year of follow-up and the total number of deaths was used to solve the inverted KM equation, which allowed reconstruction of regional data for each arm, so obtaining pooled individual patients’ data. 9 , 12 Median survivals and restricted mean survival times (RMST) were reported as descriptive measures of survival in the two treatment arms. RMST, that is the area under the KM curve, represents the average survival time experienced by cohort members.…”

Combination Therapies with Ablation: Immunoablation

“…76 Several analyses have called into question the cost effectiveness of many new cancer drugs taking into account evidence of quality-lifeyears gained. 77,78 Despite these challenges, the expansion of ablation technologies and the potential for extension of survival in patients who traditionally would not qualify for surgery is an important and exciting prospect.…”

“…The addition of anti-PDL-1 (or PDL checkpoint inhibitors) prevents this negative feedback and maximizes the immunologic effect of cryoablation. Studies have shown that cryoablation potentiates dendritic cell efficacy, degree of T-cell induction and enhances anti-PDL blockade 78.…”