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

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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.

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Acknowledgements

The authors thank Mrs. Sue Whiffin and Ms. Jenny Lowe for the excellent administrative support.

Funding

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme (14/65/01). The original report submitted by the Peninsula Technology Assessment Group to the National Institute for Health and Care Excellence on 7 August, 2015 was published in full in Health Technology Assessment [48]. Visit the HTA Programme website for further information [18]. This report presents independent research commissioned by the NIHR. The views and opinions expressed by the authors in this publication are those of the authors and do not necessarily reflect those of the National Health Service, the NIHR, Medical Research Council, the NIHR HTA Programme or the Department of Health.

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Authors and Affiliations

  1. Peninsula Technology Assessment Group (PenTAG), University of Exeter, South Cloisters 3.09, St Luke’s Campus, Heavitree Road, Exeter, EX1 2LU, UK

    Irina A. Tikhonova, Tristan Snowsill, Jo Varley-Campbell & Martin Hoyle

  2. Monash University, Melbourne, VIC, Australia

    Nicola Huxley

  3. Roboleo Ltd, York, UK

    Louise Crathorne

  4. Royal Devon and Exeter NHS Foundation Trust, Exeter, UK

    Mark Napier

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  1. Irina A. Tikhonova
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Contributions

IAT drafted the final version of the manuscript; NH, TS, LC, JVC, MN and MH revised the manuscript prior to submission. MH is the overall guarantor of the content.

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Correspondence to Irina A. Tikhonova.

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Conflict of interest

Irina A. Tikhonova, Nicola Huxley, Tristan Snowsill, Louise Crathorne, Jo Varley-Campbell, Mark Napier and Martin Hoyle have no conflicts of interest directly relevant to the content of this article.

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Tikhonova, I.A., Huxley, N., Snowsill, T. et al. Economic Analysis of First-Line Treatment with Cetuximab or Panitumumab for RAS Wild-Type Metastatic Colorectal Cancer in England. PharmacoEconomics 36, 837–851 (2018). https://doi.org/10.1007/s40273-018-0630-9

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  • DOI: https://doi.org/10.1007/s40273-018-0630-9

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