P-0247 Cost-Effectiveness of Bevacizumab Versus Cetuximab Versus Panitumumab Combined with First-Line Folfox for Metastatic Colorectal Cancer in Brazil

Abstract

ABSTRACT Introduction Treatment of metastatic colorectal cancer (mCRC) involves the use of active cytotoxic drugs and biological agents. The ideal combination in first-line therapy should be defined considering the costs, efficacy and tolerability of each regimen. The objective of this analysis, from the Brazilian public health system perspective, was to evaluate the cost-effectiveness of adding biological agents to the FOLFOX regimen in first-line treatment of mCRC. Methods A Markov model was developed to simulate mCRC patient outcomes and costs throughout first- and subsequent lines of treatment, comparing bevacizumab vs cetuximab vs panitumumab combined with the FOLFOX regimen in first-line treatment. All patients were supposed to have KRAS wild-type tumors, and be treated with the FOLFIRI regimen in second-line treatment. Data for model parameters were derived from MRC-COIN, OPUS, NO16966, and PRIME randomized studies projecting outcomes for a lifetime period. Resource use included drugs, physician visits, scans, laboratory exams, hospitalizations, and treatment of adverse events. The associated costs were obtained from price tables regulated by Brazilian Ministry of Health and are expressed in US dollars. The incremental cost per life-year gained was calculated comparing all strategies to FOLFOX alone. Results The addition of bevacizumab, cetuximab and panitumumab to first-line FOLFOX resulted in 0.08, 0.20 and 0.16 additional life-years, respectively, and incremental cost effectiveness ratios (ICERs) of $492,000, $300,000 and $317,000 per LY, respectively. The use of cetuximab was dominant over bevacizumab and panitumumab. The ICERs are mainly driven by the risk of death or progression during first-line treatment and the acquisition cost of biological agents. Conclusion The economic evaluation demonstrates that all available biologic agents are not cost-effective in combination to first-line FOLFOX regimen for wtKRAS mCRC patients. From a global perspective, the use of cetuximab was dominant over bevacizumab and panitumumab, showing that FOLFOX plus cetuximab could be the preferred combination in this population.