Economic analysis of biomarker-based anti-EGFR therapies in metastatic colorectal cancer in the Austrian context
- 34 Downloads
In metastatic colorectal cancer (mCRC), multimodal therapeutic strategies and diagnostics have continuously improved patient survival. The aim of our investigation was to relate this enhanced clinical outcome to treatment costs based on predictive biomarker scenarios guiding epidermal growth factor receptor (EGFR) targeting in a developed country.
We performed a cost-effectiveness analysis for the combination of EGFR inhibitors with chemotherapy in the first-line treatment of mCRC. Resource use estimates were based on actual data from two oncological departments and on clinical outcomes adapted from published trials. Comparative analyses for the use of EGFR inhibitors were based on three biomarker scenarios (sensitivity: 35%, 55% and 75%) to estimate their incremental cost-effectiveness and were completed by sensitivity analyses.
Using FOLFIRI+cetuximab, preselection for EGFR therapy with KRAS testing prolonged progression-free survival with average savings of 913 €/month/patient (scenario 1) and average savings of 1811 €/month/patient when testing the whole RAS-family (scenario 2). In a future but realistic scenario, up 39% of treatment costs could be saved with almost three life–years gained (LYG).
The incremental cost/LYG was 212,083 € (116,646–1,866,332 €) for unselected EGFR therapy, 32,251 € (30,294–43,488 €) for EGFR following KRAS testing, 19,172 € (15,369–28,611 €) for the all RAS scenario, and 12,369 € (3865–18,533 €) for a future biomarker scenario.
In the therapy of mCRC, predictive biomarker testing has shown to be effective and cost saving. For further improvement, a strong research focus on predictive biomarkers is considered highly efficient to promote precision oncology by alleviating the pressure on the healthcare system.
KeywordsEpidermal growth factor receptor Tumor biomarkers Cancer treatment protocols Chemotherapy Health care costs
The data were partly presented at WCGC (World Congress on Gastrointestinal Cancers) in Barcelona in 2015.
Conflict of interest
D. Niedersüß-Beke, J. Simon, M. Schiffinger, and R.M. Mader declare that they have no competing interests.
- 1.Cancer research UK. Worldwide cancer statistics. 2017. http://www.cancerresearchuk.org/health-professional/cancer-statistics/worldwide-cancer#heading-Zero. Accessed 20 July 2017.Google Scholar
- 2.National Cancer Institute. Cancer prevalence and cost of care projects. 2017. https://costprojections.cancer.gov/expenditures.html. Accessed 20 July 2017.Google Scholar
- 5.Statistik Austria. 2017. http://www.statistik.at/web_de/statistiken/menschen_und_gesellschaft/gesundheit/krebserkrankungen/dickdarm_enddarm/index.html. Accessed 20 July 2017.
- 9.Douillard JY, Siena S, Cassidy J, Tabernero J, Burkes R, Barugel M, et al. Randomized, phase III trial of panitumumab with infusional fluorouracil, leucovorin, and oxaliplatin (FOLFOX4) versus FOLFOX4 alone as first-line treatment in patients with previously untreated metastatic colorectal cancer: the PRIME study. J Clin Oncol. 2010;28(31):4697–705.CrossRefPubMedGoogle Scholar
- 11.Van Cutsem E, Kohne CH, Lang I, Folprecht G, Nowacki MP, Cascinu S, et al. Cetuximab plus irinotecan, fluorouracil, and leucovorin as first-line treatment for metastatic colorectal cancer: updated analysis of overall survival according to tumor KRAS and BRAF mutation status. J Clin Oncol. 2011;29(15):2011–9.CrossRefPubMedGoogle Scholar
- 13.Stintzing S, Jung A, Rossius L, Modest D, Fischer von Weikersthal L, Decker T, et al., editors. Mutations within the EGFR signaling pathway: Influence on efficacy in FIRE-3—A randomized phase III study of FOLFIRI plus cetuximab or bevacizumab as first-line treatment for wild-type (WT) KRAS (exon 2) metastatic colorectal cancer (mCRC) patients. Proceedings of ASCO GI. J Clin Oncol. 2014;32(Suppl 3):445 (abstr).CrossRefGoogle Scholar
- 14.Kaczirek K, Ciuleanu TE, Vrbanec D, Marton E, Messinger D, Liegl-Atzwanger B, et al. FOLFOX4 plus cetuximab for patients with previously untreated metastatic colorectal cancer according to tumor RAS and BRAF mutation status: updated analysis of the CECOG/CORE 1.2.002 study. Clin Colorectal Cancer. 2015;14(2):91–8.CrossRefPubMedGoogle Scholar
- 17.Graham CN, Hechmati G, Hjelmgren J, de Liege F, Lanier J, Knox H, et al. Cost-effectiveness analysis of panitumumab plus mFOLFOX6 compared with bevacizumab plus mFOLFOX6 for first-line treatment of patients with wild-type RAS metastatic colorectal cancer. Eur J Cancer. 2014;50(16):2791–801.CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Heinemann V, von Weikersthal LF, Decker T, Kiani A, Vehling-Kaiser U, Al-Batran SE, et al. FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer (FIRE-3): a randomised, open-label, phase 3 trial. Lancet Oncol. 2014;15(10):1065–75.CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Venook AP, Niedzwiecki D, Lenz H‑J, Innocenti F, Mahoney MR, O’Neil BH, et al., editors. CALGB/SWOG 80405: Phase III trial of irinotecan/5-FU/leucovorin (FOLFIRI) or oxaliplatin/5-FU/leucovorin (mFOLFOX6) with bevacizumab (BV) or cetuximab (CET) for patients (pts) with KRAS wild-type (wt) untreated metastatic adenocarcinoma of the colon or rectum (MCRC)2014: J Clin Oncol 32:5s, 2014 (suppl; abstr LBA3)Google Scholar
- 20.Lenz H, Niedzwiecki D, Innocenti F, editors. CALGB/SWOG 80405: Phase III trial of irinotecan/5-FU/leucovorin (FOLFIRI) or oxaliplatin/5-FU/leucovorin (mFOLFOX6) with bevacizumab (BV) or cetuximab (CET) for patients (pts) with expanded ras analyses untreated metastatic adenocarcinoma of the colon or rectum (mCRC). ESMO Conference, Abstract 501O; 2014.Google Scholar
- 21.BMG. Österreichischer Ernährungsbericht 2012. 2012. http://www.bmg.gv.at/cms/home/attachments/4/5/3/CH1048/CMS1348749794860/oeb12.pdf. Accessed 20 July 2017.Google Scholar
- 23.Nordlinger B, Van Cutsem E, Rougier P, Kohne CH, Ychou M, Sobrero A, et al. Does chemotherapy prior to liver resection increase the potential for cure in patients with metastatic colorectal cancer? A report from the European Colorectal Metastases Treatment Group. Eur J Cancer. 2007;43(14):2037–45.CrossRefPubMedGoogle Scholar