Abstract
BackgroundThe alarming increase in the cost of cancer care is forcing all stakeholders to re-evaluate their approach to treatment. Drugs are the main contributor to the cost. To evaluate the significance of drug substitution on the cost of care we assessed the economic value of panitumumab vs. cetuximab in chemo-refractory metastatic CRC (mCRC) with wild-type KRAS from a US societal perspective.MethodsWe developed a Markov model with three health states: progression-free, progressive, and death. We calculated the transition probabilities between states using the ASPECCT trial report and US life tables. Costs of drug and administration were based on the Medicare reimbursement rates. Published data were used for cost of toxicities and utilities. All costs were converted to 2017 US dollars. The model used quality-adjusted life-years (QALYs) to measure health outcomes for each treatment option.ResultsPanitumumab and cetuximab produced 0.45 QALYs at a per patient cost of $66,006 and $71,956, respectively. The incremental net monetary benefit of panitumumab compared to cetuximab is $5237 under a societal willingness-to-pay threshold of $150,000. The model showed robustness to one-way sensitivity analyses and various alternative scenarios and was found to be most sensitive to the cost of cetuximab.ConclusionsPanitumumab can lower the cost of care without impacting outcomes in chemo-refractory mCRC settings. This finding provides a strong argument to consider panitumumab in lieu of cetuximab in these patients.
Highlights
The alarming increase in the cost of cancer care is forcing all stakeholders to re-evaluate their approach to treatment
We considered the clinical efficacy, direct costs, indirect costs, and utilities to project the cost-effectiveness of one agent with the other
We calculated incremental net monetary benefits (INMB) applying the willingness-topay threshold of $150,000, which was roughly three times the US GDP per capita according to the WHO criteria for cost-effectiveness thresholds [21]
Summary
The alarming increase in the cost of cancer care is forcing all stakeholders to re-evaluate their approach to treatment. To evaluate the significance of drug substitution on the cost of care we assessed the economic value of panitumumab vs cetuximab in chemo-refractory metastatic CRC (mCRC) with wild-type KRAS from a US societal perspective. The number of agents for treatment of cancer is increasing and so is the cost of cancer care. Development of immune check point inhibitors with their broad efficacy is changing this landscape. Several immune check point inhibitors with similar efficacy and indication have regulatory approval around the world and the numbers are increasing rapidly. In 2016, an estimated 134,490 new cases and 49,190 deaths were attributed to colorectal cancer [1]. The 5-year survival rate for the mCRC population remains low at 12.5% [2, 3]
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