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Health Economic Models for Metastatic Colorectal Cancer: A Methodological Review

Author

Listed:
  • Koen Degeling

    (University of Melbourne
    University of Melbourne)

  • Martin Vu

    (University of Melbourne
    University of Melbourne)

  • Hendrik Koffijberg

    (University of Twente)

  • Hui-Li Wong

    (Walter and Eliza Hall Institute of Medical Research
    Peter MacCallum Cancer Centre)

  • Miriam Koopman

    (University Medical Centre Utrecht and Utrecht University)

  • Peter Gibbs

    (Walter and Eliza Hall Institute of Medical Research
    Western Health)

  • Maarten IJzerman

    (University of Melbourne
    University of Melbourne
    University of Twente
    Peter MacCallum Cancer Centre)

Abstract

Objective The aim of this systematic review was to provide a comprehensive and detailed review of structural and methodological assumptions in model-based cost-effectiveness analyses of systemic metastatic colorectal cancer (mCRC) treatments, and discuss their potential impact on health economic outcome estimates. Methods Five databases (EMBASE, MEDLINE, Cochrane Library, Health Technology Assessment and National Health Service Health Economic Evaluation Database) were searched on 26 August 2019 for model-based full health economic evaluations of systemic mCRC treatment using a combination of free-text terms and subject headings. Full-text publications in English were eligible for inclusion if they were published in or after the year 2000. The Consolidated Health Economic Evaluation Reporting Standards checklist was used to assess the reporting quality of included publications. Study selection, appraisal and data extraction were performed by two reviewers independently. Results The search yielded 1418 publications, of which 54 were included, representing 51 unique studies. Most studies focused on first-line treatment (n = 29, 57%), followed by third-line treatment (n = 13, 25%). Model structures were health-state driven (n = 27, 53%), treatment driven (n = 19, 37%), or a combination (n = 5, 10%). Cohort-level state-transition modelling (STM) was the most common technique (n = 33, 65%), followed by patient-level STM and partitioned survival analysis (both n = 6, 12%). Only 15 studies (29%) reported some sort of model validation. Health economic outcomes for specific strategies differed substantially between studies. For example, survival following first-line treatment with fluorouracil, leucovorin and oxaliplatin ranged from 1.21 to 7.33 years, with treatment costs ranging from US$8125 to US$126,606. Conclusions Model-based cost-effectiveness analyses of systemic mCRC treatments have adopted varied modelling methods and structures, resulting in substantially different outcomes. As models generally focus on first-line treatment without consideration of downstream treatments, there is a profound source of structural uncertainty implying that the cost-effectiveness of treatments across the mCRC pathway remains uncertain.

Suggested Citation

  • 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.
    • Handle: RePEc:spr:pharme:v:38:y:2020:i:7:d:10.1007_s40273-020-00908-4
    DOI: 10.1007/s40273-020-00908-4
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    References listed on IDEAS

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    1. Gerard Harty & James Jarrett & Mireia Jofre-Bonet, 2018. "Consequences of Biomarker Analysis on the Cost-Effectiveness of Cetuximab in Combination with FOLFIRI as a First-Line Treatment of Metastatic Colorectal Cancer: Personalised Medicine at Work," Applied Health Economics and Health Policy, Springer, vol. 16(4), pages 515-525, August.
    2. Ash Bullement & Holly L. Cranmer & Gemma E. Shields, 2019. "A Review of Recent Decision-Analytic Models Used to Evaluate the Economic Value of Cancer Treatments," Applied Health Economics and Health Policy, Springer, vol. 17(6), pages 771-780, December.
    3. Briggs, Andrew & Sculpher, Mark & Claxton, Karl, 2006. "Decision Modelling for Health Economic Evaluation," OUP Catalogue, Oxford University Press, number 9780198526629.
    4. 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.
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    Blog mentions

    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Chris Sampson’s journal round-up for 29th June 2020
      by Chris Sampson in The Academic Health Economists' Blog on 2020-06-29 11:00:06

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