Economic Analysis of First-Line Treatment with Cetuximab or Panitumumab for RAS Wild-Type Metastatic Colorectal Cancer in England
Background: Combination therapies with cetuximab (Erbitux®; Merck Serono UK Ltd) and panitumumab (Vectibix®; Amgen UK Ltd) are shown to be less effective in adults with metastatic colorectal cancer who have mutations in exons 2, 3 and 4 of KRAS and NRAS oncogenes from the rat sarcoma (RAS) family. Objective: The objective of the study was to estimate the cost effectiveness of these drugs in patients with previously untreated RAS wild-type (i.e. non-mutated) metastatic colorectal cancer, not eligible for liver resection at baseline, from the UK National Health Service and Personal Social Services perspective. Methods: We constructed a partitioned survival model to evaluate the long-term costs and benefits of cetuximab and panitumumab combined with either FOLFOX (folinic acid, fluorouracil and oxaliplatin) or FOLFIRI (folinic acid, fluorouracil and irinotecan) vs. FOLFOX or FOLFIRI alone. The economic analysis was based on three randomised controlled trials. Costs and quality-adjusted life-years were discounted at 3.5% per annum. Results: Based on the evidence available, both drugs fulfil the National Institute for Health and Care Excellence’s end-of-life criteria. In the analysis, assuming discount prices for the drugs from patient access schemes agreed by the drug manufacturers with the Department of Health, predicted mean incremental cost-effectiveness ratios for cetuximab + FOLFOX, panitumumab + FOLFOX and cetuximab + FOLFIRI compared with chemotherapy alone appeared cost-effective at the National Institute for Health and Care Excellence’s threshold of £50,000 per quality-adjusted life-year gained, applicable to end-of-life treatments. Conclusion: Cetuximab and panitumumab were recommended by the National Institute for Health and Care Excellence for patients with previously untreated RAS wild-type metastatic colorectal cancer, not eligible for liver resection at baseline, for use within the National Health Service in England. Both treatments are available via the UK Cancer Drugs Fund.
Citation
@article{i.a.2018,
author = {Tikhonova, I. A. and Huxley, N. and Snowsill, T. and
Crathorne, L. and Varley-Campbell, J. and Napier, M. and Hoyle, M.},
title = {Economic {Analysis} of {First-Line} {Treatment} with
{Cetuximab} or {Panitumumab} for {RAS} {Wild-Type} {Metastatic}
{Colorectal} {Cancer} in {England}},
journal = {PharmacoEconomics},
volume = {36},
number = {7},
pages = {837-851},
date = {2018-07-01},
url = {https://tristansnowsill.co.uk/economic-analysis-of-first-line-treatment-with.html},
doi = {10.1007/s40273-018-0630-9},
langid = {en},
abstract = {Background: Combination therapies with cetuximab
(Erbitux®; Merck Serono UK Ltd) and panitumumab (Vectibix®; Amgen UK
Ltd) are shown to be less effective in adults with metastatic
colorectal cancer who have mutations in exons 2, 3 and 4 of KRAS and
NRAS oncogenes from the rat sarcoma (RAS) family. Objective: The
objective of the study was to estimate the cost effectiveness of
these drugs in patients with previously untreated RAS wild-type
(i.e. non-mutated) metastatic colorectal cancer, not eligible for
liver resection at baseline, from the UK National Health Service and
Personal Social Services perspective. Methods: We constructed a
partitioned survival model to evaluate the long-term costs and
benefits of cetuximab and panitumumab combined with either FOLFOX
(folinic acid, fluorouracil and oxaliplatin) or FOLFIRI (folinic
acid, fluorouracil and irinotecan) vs. FOLFOX or FOLFIRI alone. The
economic analysis was based on three randomised controlled trials.
Costs and quality-adjusted life-years were discounted at 3.5\% per
annum. Results: Based on the evidence available, both drugs fulfil
the National Institute for Health and Care Excellence’s end-of-life
criteria. In the analysis, assuming discount prices for the drugs
from patient access schemes agreed by the drug manufacturers with
the Department of Health, predicted mean incremental
cost-effectiveness ratios for cetuximab + FOLFOX, panitumumab +
FOLFOX and cetuximab + FOLFIRI compared with chemotherapy alone
appeared cost-effective at the National Institute for Health and
Care Excellence’s threshold of £50,000 per quality-adjusted
life-year gained, applicable to end-of-life treatments. Conclusion:
Cetuximab and panitumumab were recommended by the National Institute
for Health and Care Excellence for patients with previously
untreated RAS wild-type metastatic colorectal cancer, not eligible
for liver resection at baseline, for use within the National Health
Service in England. Both treatments are available via the UK Cancer
Drugs Fund.}
}