BACKGROUND:
The ASPECCT trial was a phase 3 head-to-head randomized
noninferiority study comparing the efficacy and safety of epidermal
growth factor receptor inhibitors (anti-EGFRs), panitumumab
and cetuximab, in patients with previously treated, chemotherapy resistant
or intolerant, wild-type (WT) KRAS exon 2 metastatic colorectal
cancer (mCRC). Trial results indicated similar median overall survival
(OS; HR = 0.97, 95% CI: 0.84-1.11), and similar median progressionfree
survival (PFS; HR = 1.00, 95% CI: 0.88-1.14). Given this similar
efficacy, economic modeling may assist decision makers in determining
the relative monetary value of one treatment versus another in a context
of healthcare budgetary challenges and constraints.
OBJECTI VE: To compare the costs of treatment with panitumumab
versus cetuximab among chemorefractory patients with WT KRAS
mCRC.
METHODS: A cost-minimization model was developed based on similar
treatment efficacy. The model estimated the costs associated with
drug acquisition, treatment administration frequency (every 2 weeks
for panitumumab, weekly for cetuximab), and incidence of infusion
reactions. Average anti-EGFR doses were calculated from ASPECCT.
Using the medical component of the consumer price index, adverse
event costs were inflated to 2014 U.S. dollars, and all other costs were
reported in 2014 U.S. dollars. The time horizon for the model was
based on mean PFS, estimated from parametric survival analyses of
ASPECCT data.
RESULTS: Relative to cetuximab in the treatment of chemotherapy
resistant or intolerant patients with WT KRAS mCRC, the costminimization
model estimated lower projected drug acquisition,
administration, and adverse event costs for patients who received
panitumumab. The overall cost per patient was $47,679 for panitumumab
versus $59,630 for cetuximab, resulting in a per-patient savings
of $11,952 (20%). Drug acquisition costs alone were 17% less with
panitumumab ($46,179 vs. $55,963).
CONCLUSIONS: From a value perspective, the cost-minimization
model supports panitumumab versus cetuximab as a preferred treatment
option for chemorefractory WT KRAS mCRC patients.
Economic analysis of panitumumab versus cetuximab in chemorefractory patients with wild-type KRAS metastatic colorectal cancer (PDF Download Available). Available from: http://www.researchgate.net/publication/274732828_Economic_analysis_of_panitumumab_versus_cetuximab_in_chemorefractory_patients_with_wild-type_KRAS_metastatic_colorectal_cancer [accessed Jun 10, 2015].
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