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Cost-Effectiveness Analysis of Encorafenib, Binimetinib, and Cetuximab in BRAF V600E-Mutated Metastatic Colorectal Cancer in the USA

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Abstract

Introduction

Recently the phase 3 BEACON trial showed that the combination of encorafenib, cetuximab, and binimetinib versus cetuximab and irinotecan/FOLFIRI improved overall survival in pre-treated patients with metastatic colorectal cancer (mCRC) with BRAF V600E mutation. However, whether the benefits of these therapies justify their high costs has not been estimated in the USA. The purpose of this study was to evaluate the cost-effectiveness of BEC (binimetinib, encorafenib, and cetuximab), EC (encorafenib and cetuximab), and CI/CF (cetuximab with irinotecan or FOLFIRI) in patients with BRAF V600E-mutated mCRC after first- and second-line therapy.

Methods

A Markov model was constructed to determine the costs and effects of BEC, EC, and CI/CF on the basis of BEACON trial outcomes data. Health outcomes were measured in life years (LYs), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). Deterministic and probabilistic sensitivity analyses characterized parameters influencing cost-effectiveness. Subgroup analyses were conducted as well.

Results

The QALYs gained in BEC, EC, and CI/CF were 0.62, 0.54, and 0.40, respectively. BEC resulted in ICERs of $883,895.73/QALY and $1,646,846.14/QALY versus CI/CF and EC, respectively. Compared with CI/CF, the ICER was $435,449.88/QALY in EC. The most sensitive parameters in the comparison among the three arms were the utilities of progressive disease and progression-free survival. Probabilistic sensitivity analyses showed that the probability of BEC and EC being cost-effective was 0%. In subgroup analyses, the ICER remained above the willingness-to-pay threshold of $150,000 per QALY.

Conclusion

BEC and EC were not cost-effective regimens for patients with pre-treated mCRC with BRAF V600E mutation.

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Acknowledgements

Funding

This manuscript, including the journal’s Rapid Service Fee, was supported by grants from the Hunan Natural Science Foundation of China (No. 2018JJ3852). All authors had full access to all of the data in this study and took complete responsibility for the integrity and accuracy of the data.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosures

Shuosha Li, Huabin Hu, Dong Ding, Youwen Zhu, Jin Huang have nothing to disclose.

Compliance with Ethics Guidelines

This article is based on previously conducted studies and does not contain any human participant or animal study. Ethics committee approval is not required.

Data Availability

All data generated or analyzed during this study are available from the corresponding author on reasonable request.

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Author notes

  1. Shuosha Li and Huabin Hu contributed equally to this work.

Authors and Affiliations

  1. Department of Oncology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China

    Shuosha Li, Dong Ding, Youwen Zhu & Jin Huang

  2. Department of Medical Oncology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China

    Huabin Hu

  3. Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou, 510655, China

    Huabin Hu

  4. Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China

    Jin Huang

Authors
  1. Shuosha Li
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Correspondence to Jin Huang.

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Li, S., Hu, H., Ding, D. et al. Cost-Effectiveness Analysis of Encorafenib, Binimetinib, and Cetuximab in BRAF V600E-Mutated Metastatic Colorectal Cancer in the USA. Adv Ther 38, 1650–1659 (2021). https://doi.org/10.1007/s12325-021-01627-8

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