Real-world cost-effectiveness of cetuximab in the third-line treatment of metastatic colorectal cancer based on patient chart review in the Netherlands

Abstract

ObjectiveTo assess the cost effectiveness of cetuximab in third-line treatment of patients with KRAS wild-type (wt) metastatic colorectal cancer (mCRC) in routine clinical practice compared with best supportive care (BSC).MethodsPatients (n = 287) with KRAS wt mCRC treated with cetuximab or BSC in eight hospitals in the Netherlands between 2009 and 2012 were included in our real-world study. Outcome measures were costs per life-year (LY) and costs per quality-adjusted LY (QALY) gained. A Markov model was developed, and a time horizon of four years was applied. Outcomes were calculated from Kaplan-Meier survival curves from patient-level data and literature. Direct medical costs were estimated in all centers (2013 values), and incremental cost-effectiveness ratios (ICERs) were calculated. Results were discounted, and a probabilistic sensitivity analysis was performed.ResultsAdministration of cetuximab in third-line treatment of mCRC resulted in a gain of 0.29 LYs and 0.25 QALYs compared with BSC. In the four-year study period, average discounted healthcare costs were €36,637 in the cetuximab group vs. €3648 in the BSC group. The discounted ICERs of cetuximab vs. BSC in the real-world setting were €114,907and €133,527 per LY and QALY gained, respectively.ConclusionsResults of this cost-effectiveness analysis showed that third-line treatment with cetuximab for patients with KRAS (exon 2) wt mCRC offered clinical benefits at additional cost. The real-world ICERs were in line with those of previously published cetuximab and panitumumab cost-utility models.

Cost-effectiveness of procalcitonin testing to guide antibiotic treatment duration in critically ill patients: results from a randomised controlled multicentre trial in the Netherlands

“…Owing to the severity of sepsis, a WTP threshold of €80,000/QALY is most likely applicable, although the results will also be analysed using a WTP threshold of €20,000/QALY. Similarly, the high WTP threshold is also used in interventions for metastatic breast, lung, or colorectal cancer, and for bypass surgery or percutaneous coronary intervention [ 31 – 34 ]. In some conditions, the ICUR may however be much higher, as illustrated by an ICUR of €133,527 per QALY gained for chemotherapy treatment (i.e.…”

“…In some conditions, the ICUR may however be much higher, as illustrated by an ICUR of €133,527 per QALY gained for chemotherapy treatment (i.e. cetuximab) vs. best supportive care in metastatic colorectal cancer [ 34 ].…”

Health Economic Models for Metastatic Colorectal Cancer: A Methodological Review

“…Only 17 studies (33%) reported individual patient data (IPD) as the source of evidence on treatment efficacy, 13 of which used data from randomized trials and four used observational data [47,48,63,77]. Eleven (85%) out of 13 studies that had access to IPD from randomized trials were funded by industry.…”

“…the shape and scale parameters of a Weibull distribution) or time-dependent transition probabilities should be accounted for [91]. Of all 22 studies that accounted for uncertainty in time-to-event related parameters, only a few reflected correlation between distribution parameters [30,39,51,52,64,91] or reflected uncertainty in median or mean survival based on which parameters were estimated [32,40,45], whereas others used beta distributions for individual probabilities and hazard ratios [35,46,48,55,69], other distributions [49,67,75,77,81], or provided no information [36,42,56,73]. This indicates a need for increased awareness of the importance of reflecting uncertainty in time-to-event parameters and the appropriate methods to do so.…”

Thermodynamic study of BRAF V600 mutations in colorectal cancer patients

“…Evidently, the different hydrogen-bonding and stacking in G/T and G/A mismatches results in different thermodynamic trends. BRAF V600E mutation testing has demonstrated utility in helping select CRC patients who are considering monoclonal antibody therapy as wild-type BRAF is required for response to anti-EGFR antibodies 23 and improve diagnostic accuracy in thyroid FNA samples. 12,13 In addition, BRAF V600E mutation is connected with sporadic microsatellite instable CRC, but not hereditary non-polyposis colorectal cancer (HNPCC) syndrome.…”