Abstract
ObjectivesWe aimed to compare the economic value of chemotherapy plus anti-epidermal growth factor receptor (anti-EGFR) monoclonal antibody (mAb) against chemotherapy with bevacizumab (Bev, an anti-vascular endothelial growth factor mAb) as first-line treatment in KRAS wild-type (WT), pan-RAS WT and pan-RAS WT left-sided metastatic colorectal cancer (mCRC) patients from the Hong Kong societal perspective.Materials and MethodsWe developed Markov models and 10-year horizon to estimate costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER) of chemotherapy plus anti-EGFR therapy against chemotherapy plus Bev in KRAS WT, pan-RAS WT, and pan-RAS WT left-sided mCRC. We considered two times of the local gross domestic product per capita (GDPpc) as the willingness-to-pay (WTP) threshold (2× GDPpc; US$97,832).ResultsAdding anti-EGFR mAb to chemotherapy provides additional 0.24 (95% confidence interval [CI] 0.19–0.29), 0.32 (95% CI 0.27–0.37), and 0.57 (95% CI 0.49–0.63) QALY compared to adding Bev in KRAS WT, pan-RAS WT, and left-sided pan-RAS WT mCRC populations respectively. The corresponding ICER is US$106,847 (95% CI 87,806–134,523), US$88,565 (95% CI 75,678–105,871), US$76,537 (95% CI 67,794–87,917) per QALY gained, respectively.ConclusionsAnti-EGFR therapy is more cost-effective than Bev as a first-line targeted therapy in left-sided pan-RAS WT and pan-RAS WT, with ICER <US$100,000/QALY, compared to KRAS WT mCRC population.
Highlights
Colorectal cancer (CRC) is a significant global health burden
The introduction of molecular targeted therapy has dramatically improved the prognosis of metastatic colorectal cancer patients, with their median survival doubled from 14–16 months to over 30 months [1,2,3,4,5]
We modeled a hypothetical cohort of patients with KRAS WT metastatic colorectal cancer (mCRC) with the same characteristics as those of patients enrolled into the selected randomized controlled trials (RCTs) (FIRE-3, CALGB 80405, and PEAK) as the base case [4,5,6, 10,11,12,13,14,15,16]
Summary
Colorectal cancer (CRC) is a significant global health burden. Over the past decades, the introduction of molecular targeted therapy has dramatically improved the prognosis of metastatic colorectal cancer (mCRC) patients, with their median survival doubled from 14–16 months to over 30 months [1,2,3,4,5]. Combination chemotherapy plus targeted therapy, either antiepidermal growth factor receptor (anti-EGFR) monoclonal antibody (mAb) or anti-vascular endothelial growth factor (anti-VEGF) mAb have become the current standard firstline treatment. Both anti-EGFR mAb and bevacizumab (Bev, an anti-VEGF mAb) have demonstrated their efficacies as first-line therapies in KRAS wild-type (WT) patients. The CALGB 80405 trial, which is the largest one, has demonstrated equivalence of antiEGFR mAb and bevacizumab in terms progression-free survival (PFS) and overall survival (OS) [5] Both the FIRE3 and the PEAK studies have suggested the superiority of antiEGFR therapy [4, 6]. The primary tumor location (PTL) has been validated as a response predictor of anti-EGFR mAb, whose benefit is mainly seen in patients of left-sided but not right-sided colonic tumors [10,11,12]
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