Real-world cost-effectiveness of cetuximab in locally advanced squamous cell carcinoma of the head and neck

Abstract

Clinical trial EMR 62202-006 demonstrates prolonged median locoregional control (24.4 vs. 14.9 months), progression-free survival (17.1 vs. 12.4 months) and overall survival (49.0 vs. 29.3 months) for patients who receive cetuximab added to the comparator radiotherapy for locally advanced squamous cell carcinoma of the head and neck (LA SCCHN). In the Netherlands, hospitals receive reimbursement for cetuximab conditional on cost-effectiveness in daily practice. To estimate the real-world incremental cost per quality adjusted life-year (QALY) gained for radiotherapy + cetuximab over radiotherapy alone in first line treatment of LA SCCHN, a Markov model is constructed with health states "alive without progression", "alive following progression" and "death". Transition probabilities per month are estimated from clinical trial data and retrospectively collected real-world data from two Dutch head and neck cancer treatment centres (2007-2010, n = 141). 5-year, 10-year and lifetime horizons are used, without and with discounting (4 % costs, 1.5 % effects) to calculate incremental cost-effectiveness ratios. Two scenarios explore different assumptions on prognosis of real-world versus trial patients. Adding cetuximab to radiotherapy results in increased costs and health gains in both scenarios and across each of the time horizons. Incremental costs per QALY gained range between <euro>14,624 and <euro>38,543 in the base-case. For a willingness to pay of <euro>80,000 per QALY, the acceptability curves for the different scenarios show probabilities between 0.76 and 0.87 of radiotherapy + cetuximab being cost-effective compared to radiotherapy alone. Current results show the combined treatment of radiotherapy + cetuximab to be a cost-effective treatment option for patients with LA SCCHN.

EGFR amplification and expression in oral squamous cell carcinoma in young adults

“…Radiation combined with EGFR inhibitors has been used successfully for the local treatment of advanced head and neck tumours 15 . However, in view of the high cost of anti-EGFR therapy 16 , it is necessary to identify the group that will best respond to this therapy, as suggested by Galvis et al 17 . The aim of this study was to investigate EGFR alterations in two groups of patients with OSCC (a test group of subjects aged 40 years and a control group of subjects aged !50 years) and to associate the results with EGFR immunostaining, clinicopathological features, and the prognosis.…”

Consenso multidisciplinario y multiinstitucional de la utilidad del cetuximab en el tratamiento de los pacientes con carcinoma epidermoide de cabeza y cuello

“…Otro estudio de farmacoeconomía apoya el uso de CTX concomitante con RT 52 . Para estimar el costo incremental en el mundo real por AVAC con el esquema CTX/RT en comparación con la RT sola como primera línea terapéutica, se construyó un modelo de Markov con las siguientes clasificaciones: vivos sin progresión, vivos con progresión y fallecidos.…”

“…Los costos incrementales por AVAC ganado oscilan entre 14.624 y 38.543 euros, y las curvas de aceptabilidad para los diferentes escenarios muestran probabilidades entre 0,76 y 0,87 para CTX/RT, siendo rentable en comparación con la RT sola. En resumen, los resultados actuales muestran que el tratamiento combinado de CTX/RT es una opción de tratamiento costo-efectiva para los pacientes con CE-CC localmente avanzado 52 .…”

Balancing the Optimal and the Feasible: A Practical Guide for Setting Up Patient Registries for the Collection of Real-World Data for Health Care Decision Making Based on Dutch Experiences

“…Table 1 provides an overview of the mission and goals of the registries in which we are involved. All registries ensure transparency to the public through presentations and publications [7][8][9][10][11][12][13][14]. However, only the melanoma registry (Dutch Melanoma Treatment Registry [DMTR]) fortnightly provides clinicians with online benchmarked feedback regarding a predefined set of quality indicators developed by the professional organization.…”