Cost-Effectiveness Analysis of Monoclonal Antibodies Associated With Chemotherapy in First-Line Treatment of Metastatic Colorectal Cancer

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Data
2023
Autores
Barufaldi, Laura A.
Albuquerque, Rita de C.R. de
Nascimento, Aline do
Martins, Luís Felipe L.
Zimmermann, Ivan R.
Souza, Mirian C. de
Journal Title
Journal ISSN
Volume Title
Publisher
Value in Health Regional Issues
Resumo
Objectives: This study aimed to evaluate the cost-effectiveness of anti–epidermal growth factor receptor (cetuximab and panitumumab) or anti–vascular endothelial growth factor (bevacizumab) monoclonal antibodies associated with conventional chemotherapy (CT) (fluorouracil and leucovorin with irinotecan) as a first-line treatment for unresectable metastatic colorectal cancer. Methods: A partitioned survival analysis model was adopted to simulate direct health costs and benefits comparing thera- peutic options in a 10 years’ time horizon. Model data were extracted from the literature and costs were obtained from Brazilian official government databases. The analysis considered the perspective of the Brazilian Public Health System; costs were measured in local currency (BRL) and benefits in quality-adjusted life-years (QALY). A 5% discount rate was applied to costs and benefits. Alternative willingness-to-pay scenarios, varying from 3 to 5 times the cost-effectiveness threshold established in Brazil, were estimated. The results were presented incremental cost-effectiveness ratio (ICER), and both deterministic and probabilistic sensitivity analyses were performed. Results: The most cost-effective choice would be the association of CT with panitumumab, with an ICER of $58 330.15/QALY compared with isolated CT. The second-best option was CT with bevacizumab and panitumumab, with an ICER of $71 195.40/ QALY compared with panitumumab alone. Although having higher costs, the second-best option was the most effective. Both strategies were cost-effective in part of the Monte Carlo iterations, considering the 33 threshold. Conclusions: The therapeutic option CT 1 panitumumab 1 bevacizumab represents the most significant effectiveness gain in our study. It is the second-lowest cost-effectiveness, and this option includes monoclonal antibodies association for patients with and without KRAS mutation.
Description
Palavras-chave
antibodies, colorectal neoplasms, cost-effectiveness evaluation, health evaluation, monoclonal, neoplasm metastasis
Citação
Barufaldi LA, de Albuquerque RCR, do Nascimento A, Martins LFL, Zimmermann IR, de Souza MC. Cost-Effectiveness Analysis of Monoclonal Antibodies Associated With Chemotherapy in First-Line Treatment of Metastatic Colorectal Cancer. Value Health Reg Issues. 2023 Sep;37:33-40. doi: 10.1016/j.vhri.2023.04.003