PCN93 - Cost-Effectiveness of Cetuximab+Folfiri Versus Folfiri At The Public Healthcare System In Brazil – The Crystal Trial Ras Subgroup Economic Perspective

Abstract

Colorectal cancer is the second cause of cancer-related mortality worldwide. In Brazil, the National Cancer Institute estimated the occurrence of 32,600 new colorectal cancer cases (15,070 cases in males and 17,530 cases in females) for 2014. Considering the disease impact and the recent findings of relevant clinical trials under new biomarkers’ evaluations in the RAS gene, we developed a cost-effectiveness analysis evaluating the use of cetuximab in combination with FOLFIRI (folinic acid, fluorouracil and irinotecan) compared to FOLFIRI alone for metastatic colorectal cancer (mCRC) in RAS wild-type patients, in the public health care system in Brazil. To estimate the costs and outcomes of the treatments we designed a Markov model in which patients with mCRC were evaluated considering the natural course of the disease during a time horizon of 10 years. The outcomes were evaluated in terms of life year saved. Efficacy data was retrieved primarily from the CRYSTAL trial, recently evaluated in light of the new RAS biomarker. Only direct 2014 medical costs were considered. Costs were obtained from the public database DATASUS. Costs and outcomes were discounted to present value at a 5% annual rate. In the comparison with cetuximab+FOLFIRI vs FOLFIRI, the incremental effectiveness estimated was 0.7 life years, with an incremental cost of BRL 46,007.34, representing a cost-effectiveness ratio of 66,090.91. Considering a GDP per capita of BRL 24,065.00, the ICER calculated could be considered cost-effective since it would fall under the threshold of 3 times the GDP per capita. Cetuximab+FOLFIRI has shown to be cost-effective in mCRC RAS wild-type patients, enabling a significant and clinically meaningful increase in survival supported by the new findings from the CRYSTAL trial in the RAS population subgroup.