Cost-effectiveness Analysis of Panitumumab Plus mFOLFOX6 Compared to Bevacizumab Plus mFOLFOX6 for First-line Treatment of Patients with Wild-type RAS Metastatic Colorectal Cancer - Czech Republic Model Adaptation
Abstract
Background: Pharmacoeconomic assessments are a part of the decision process not only during reimbursement setting, but in clinical practice as well. The presented cost-effectiveness analysis assesses panitumumab + mFOLFOX6 vs. bevacizumab + mFOLFOX6 in 1st line treatment of patients with wild-type RAS metastatic colorectal cancer (mCRC) in the Czech environment.
Material and Methods: The adaptation of a Markov model considers the health- care perspective; clinical data (efficacy, health- care utilization and adverse events) are derived from a head- to- head comparison (PEAK study). Health states included in the model: progression free on treatment, progression (with/ without active treatment), resection of metastases, disease-free after successful resection and death.
Actual reimbursement levels were used to estimate costs, published literature to estimate duration of 2nd line treatment. The analysis assumes a life- time horizon; uncertainty was limited by performing one- way and probabilistic sensitivity analyses.
Analysis outcomes are life-years gained (LYG) and quality-adjusted life-years (QALYs). Results: Panitumumab + mFOLFOX6 is more effective and more costly in 1st line patients with wild-type RAS mCRC.
Incremental costs per QALY are 837,270 CZK, per LYG 615,022 CZK; however, below the willingness-to-pay threshold applied in the Czech Republic. Conclusions: Panitumumab + mFOLFOX6 is cost-effective in 1st line treatment of patients with wild-type RAS mCRC compared to bevacizumab + mFOLFOX6 in the Czech setting.