Utilization and costs of non-evidence-based (non-EBM) antineoplastic agents in patients with metastatic colon cancer (mCC).

Abstract

6002 Background: New biologic and cytotoxic therapies have successfully improved mCC survival, yet have the potential to increase the use of non-EBM regimens. Insight into utilization patterns of non-EBM antineoplastic drugs is crucial as new reimbursement methods and evidence-based clinical pathways are being developed. Methods: Using UnitedHealthcare data, we retrospectively identified incident cases of mCC from 01/2007 to 06/2010. We excluded patients (pts) with multiple primary tumors and evaluated the use of 3 regimens not recommended by the NCCN Guidelines: 1) Bevacizumab (BEV) beyond progression on a BEV/chemotherapy regimen (addressed as “insufficient data to support” in the NCCN guidelines); 2) Single agent capecitabine (CAPE) as a salvage therapy after failure on a fluoropyridimidine-containing regimen (NCCN: “shown to be ineffective”); 3) Panitumumab (PAN) or cetuximab after progression on a prior epidermal growth factor receptor antibody (NCCN: “no data, nor is there a compelling rationale”). Sensitivity analyses of key assumptions for the mCC cohort selection and for treatment definitions were performed, as well as analyses examining non-EBM use based on pts’ age, line of treatment, co-morbidities and geographic area. Results: A total of 7642 colon cancer cases were identified, and 1041 (14%) developed mCC. Of those, 140 (13%) received at least one of the 3 non-EBM therapies; 884 pts received BEV, and 91 (10%) of those received it as non-EBM; CAPE was administered to 121 pts, 59 (49%) non-EBM; 38 pts received PAN and 6 (16%) received it non-EBM. The total cost to acquire the non-EBM drugs was estimated at $2,009,480 ($1,930/mCC case). Conclusions: In a large privately insured mCC cohort, a substantial number of pts received non-EBM therapies. This resulted in a high social cost for the pts (who may have experienced toxicities without proven benefits), and for payers. Further study is warranted to identify patient and physician factors associated with use of non-EBM regimens. Non-EBM cycles (n) Estimated drug costs from a CMS perspective ($) BEV 632 1,318,352 CAPE 218 621,463 PAN 19 69,665 2011 average sales price (70kg, 170cm, male): BEV $5.96/mg, CAPE $0.045/mg and PAN $8.73/mg.