Cost-Effectiveness Analysis of Monoclonal Antibodies Associated With Chemotherapy in First-Line Treatment of Metastatic Colorectal Cancer

• Published in: Value in health regional issues 2023-09, Vol.37, p.33-40
• Main Authors: Barufaldi, Laura A., de Albuquerque, Rita de C.R., do Nascimento, Aline, Martins, Luís Felipe L., Zimmermann, Ivan R., de Souza, Mirian C.
• Format: Article
• Language: English
• Subjects: antibodies; colorectal neoplasms; cost-effectiveness evaluation; health evaluation; monoclonal; neoplasm metastasis
• ISSN: 2212-1099; 2212-1102
• DOI: 10.1016/j.vhri.2023.04.003

This study aimed to evaluate the cost-effectiveness of anti–epidermal growth factor receptor (cetuximab and panitumumab) or anti–vascular endothelial growth factor (bevacizumab) monoclonal antibodies associated with conventional chemotherapy (CT) (fluorouracil and leucovorin with irinotecan) as a first-line treatment for unresectable metastatic colorectal cancer. A partitioned survival analysis model was adopted to simulate direct health costs and benefits comparing therapeutic options in a 10 years’ time horizon. Model data were extracted from the literature and costs were obtained from Brazilian official government databases. The analysis considered the perspective of the Brazilian Public Health System; costs were measured in local currency (BRL) and benefits in quality-adjusted life-years (QALY). A 5% discount rate was applied to costs and benefits. Alternative willingness-to-pay scenarios, varying from 3 to 5 times the cost-effectiveness threshold established in Brazil, were estimated. The results were presented incremental cost-effectiveness ratio (ICER), and both deterministic and probabilistic sensitivity analyses were performed. The most cost-effective choice would be the association of CT with panitumumab, with an ICER of $58 330.15/QALY compared with isolated CT. The second-best option was CT with bevacizumab and panitumumab, with an ICER of $71 195.40/QALY compared with panitumumab alone. Although having higher costs, the second-best option was the most effective. Both strategies were cost-effective in part of the Monte Carlo iterations, considering the 3× threshold. The therapeutic option CT + panitumumab + bevacizumab represents the most significant effectiveness gain in our study. It is the second-lowest cost-effectiveness, and this option includes monoclonal antibodies association for patients with and without KRAS mutation. •To the best of our knowledge, this is the first study to estimate the cost-effectiveness of first-line treatment for unresectable metastatic colorectal cancer. The treatments options assessed were anti–epidermal growth factor receptor (cetuximab and panitumumab) or anti–vascular endothelial growth factor (bevacizumab) monoclonal antibodies associated with conventional chemotherapy with fluorouracil and leucovorin with irinotecan in the perspective of the Brazilian Unified Health System.•The presented model compared different drug incorporation alternatives for the 2 KRAS status types and seeks to represent actual decisi