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Economic Analysis of First-Line Treatment with Cetuximab or Panitumumab for RAS Wild-Type Metastatic Colorectal Cancer in England

Author

Listed:
  • Irina A. Tikhonova

    (Peninsula Technology Assessment Group (PenTAG), University of Exeter)

  • Nicola Huxley

    (Monash University)

  • Tristan Snowsill

    (Peninsula Technology Assessment Group (PenTAG), University of Exeter)

  • Louise Crathorne

    (Roboleo Ltd)

  • Jo Varley-Campbell

    (Peninsula Technology Assessment Group (PenTAG), University of Exeter)

  • Mark Napier

    (Royal Devon and Exeter NHS Foundation Trust)

  • Martin Hoyle

    (Peninsula Technology Assessment Group (PenTAG), University of Exeter)

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.

Suggested Citation

  • Irina A. Tikhonova & Nicola Huxley & Tristan Snowsill & Louise Crathorne & Jo Varley-Campbell & Mark Napier & Martin Hoyle, 2018. "Economic Analysis of First-Line Treatment with Cetuximab or Panitumumab for RAS Wild-Type Metastatic Colorectal Cancer in England," PharmacoEconomics, Springer, vol. 36(7), pages 837-851, July.
    • Handle: RePEc:spr:pharme:v:36:y:2018:i:7:d:10.1007_s40273-018-0630-9
    DOI: 10.1007/s40273-018-0630-9
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    Cited by:

    1. Koen Degeling & Martin Vu & Hendrik Koffijberg & Hui-Li Wong & Miriam Koopman & Peter Gibbs & Maarten IJzerman, 2020. "Health Economic Models for Metastatic Colorectal Cancer: A Methodological Review," PharmacoEconomics, Springer, vol. 38(7), pages 683-713, July.

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