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