The Cost of Survival Gains in Metastatic Colorectal Cancer (Mcrc) in Four European Countries

Abstract

ABSTRACT Aim: Innovative therapies for mCRC prolong life when added to conventional chemotherapies, but also increase the cost. Methods: Drug acquisition costs for standard oxaliplatin- and irinotecan-based chemotherapies and innovative therapies (VEGF and EGFR inhibitors) were collected from publicly available sources for France, Germany, Spain, and Italy. Published trials were reviewed to collect the median progression-free survival (mPFS) and overall survival (mOS) for chemotherapies with add-on innovative therapies. Studies were included if add-on therapy demonstrated statistically significant mOS benefit. Treatment duration was not consistently reported for all trials, so mPFS was used as a proxy. The cost of drug regimens for 1st, 2nd, and 3rd therapy lines were calculated and compared with respect to incremental mOS benefits. Results: In 1st line, adding innovative therapy extended mOS an average of 4.1 months for an average additional cost of 35,600 to 59,900 e per patient across the four countries. Average 2nd-line improvement in mOS was 1.6 months, with additional costs of 19,400 to 31,100 e. Average 3rd-line mOS improvement was 4.7 months, with additional costs of 15,500 to 25,300 e. Conclusions: Based on published trials and drug prices, EU countries pay 3,300 to 19,500 e per month of survival gain with innovative therapies. The additional cost per month is highest in 2nd line; the value of an additional month may vary across lines due to differences in life expectancy. Regimen Add-on Drug mPFS (months) mOS (months) mOS Increase (months) Additional Cost (e) 1st-line IFL Hurwitz 2004 Bevacizumab – 10.6 6.2 20.3 15.6 4.7 26,200 to 42,300 FOLFIRI Van Cutsem 2011 Cetuximab – 9.9 8.4 23.5 20.0 3.5 40,000 to 67,800 FOLFOX4 Douillard 2014 Panitumumab – 10.0 8.6 23.9 19.7 4.2 38,700 to 69,600 2nd-line FOLFOX4 Giantonio 2007 Bevacizumab – 7.3 4.7 12.9 10.8 2.1 33,500 to 55,100 Oxaliplatin- or irinotecan- based chemo Bennouna 2012 Bevacizumab – 5.7 4.1 11.2 9.8 1.4 13,600 to 24,700 FOLFIRI Van Cutsem 2012 Aflibercept – 6.90 4.67 13.50 12.06 1.4 19,900 to 29,800 3rd-line BSC Karapetis 2008 Cetuximab * – 3.7 1.9 9.5 4.8 4.7 15,500 to 25,300 * efficacy based on a retrospective analysis of Phase 3 trial data, in which tumor samples were not available for all randomized patients. Disclosure: I. Ozer-Stillman, J. Whalen and A. Ambavane: Employee of Evidera, Inc. which is paid to conduct research by drug manufacturers; G. Pietsch, C. Ngai, A. Mohamed and J. Chang: Employee of Bayer, which manufacturers regorafenib, a targeted therapy for metastatic colorectal cancer.