Cost effectiveness of maintenance bevacizumab in patients with metastatic colorectal cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 718-718
Author(s):  
Joel Lange ◽  
Rahul Rajeev ◽  
T. Clark Gamblin ◽  
Kiran Turaga
Keyword(s):  
Colorectal Cancer ◽  
Cost Effectiveness ◽  
Metastatic Colorectal Cancer ◽  
Sensitivity Analyses ◽  
Drug Pricing ◽  
Wide Range ◽  
Quality Of Life Scale ◽  
Global Quality Of Life ◽  
The Cost ◽  
Quality Adjusted Life

718 Background: Observation alone after initial treatment of unresectable metastatic colorectal cancer is often anxiety provoking for physician and patient alike. The CAIRO 3 trial suggested the efficacy of maintenance capecitabine and bevacizumab in improving overall survival for such patients. We hypothesized that the cost effectiveness for maintenance capecitabine and bevacizumab would be worse than accepted population thresholds. Methods: Data from the CAIRO-3 trial was used to populate a semi-markov model, in which patients transitioned between different disease and complication based states. Transition probabilities were extratcted from the trial. Costs were determined from a thirs payer persective from the Medicare part B ASP drug pricing file. Utility was converted from the global quality of life scale. Incremental cost effectiveness ratios were calculated. Results: Cost of the maintenance arm after 10 cycles was $108,848 with a gain in 14.93 quality adjusted life months, while the quality adjusted life months gained at no cost in the observation arm was 13.67. This yielded an ICER of $1,036,648/QALY. Two way sensitivity analyses demonstrated dominance of observation across a wide range of parameters unless the cost per cycle was < $6250. Conclusions: Maintenance capecitabine and bevacizumab is not cost effective and is higher than the willingness to pay threshold for any developed nation. Reducing drug pricing is the only way to financially support the argument for this treatment strategy.

Cost-effectiveness analysis of fruquintinib as third-line treatment for patients with metastatic colorectal cancer

2020 ◽  
Vol 106 (5) ◽  
pp. 400-405 ◽  
Author(s):  
Peng-Fei Zhang ◽  
Dan Xie ◽  
Qiu Li
Keyword(s):  
Colorectal Cancer ◽  
Cost Effectiveness ◽  
Metastatic Colorectal Cancer ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Line Treatment ◽  
Effectiveness Analysis ◽  
Third Line ◽  
The Cost ◽  
Third Line Treatment

Objective: To evaluate the cost-effectiveness of addition of fruquintinib to best supportive care (BSC) in third-line treatment for patients with metastatic colorectal cancer (CRC). Methods: To conduct the cost-effectiveness analysis, a Markov model was established to simulate the course of metastatic CRC. Three health states—progression-free survival (PFS), progressive disease (PD), and death—were included. Clinical data were derived from the FRESCO trial and health utility values were extracted from previous literature. The primary outcome of the study was incremental cost-effectiveness ratio (ICER) in US dollars per quality-adjusted life-years (QALYs) from a Chinese societal perspective. One-way sensitivity analyses and probabilistic sensitivity analyses were performed to test the robustness of the study. Results: Addition of fruquintinib to BSC gained 0.54 QALY at a cost of $15,404.57 while the BSC group gained 0.38 QALY at a cost of $9603.94. ICER of fruquintinib versus BSC was $36,253.94/QALY. In the 1-way sensitivity analyses, utility for PD in both groups, utility for PFS in both groups, and cost of fruquintinib significantly influenced the results of the analysis. At the willingness-to-pay threshold of $28,988.40/QALY, probabilities of addition of fruquintinib to BSC or BSC alone as the cost-effective option were 0% and 100%, indicating addition of fruquintinib is not a dominant option compared with BSC. Conclusions: Addition of fruquintinib to BSC is not a cost-effective regimen in the third-line setting for patients with metastatic CRC from the Chinese societal perspective.

Cost-effectiveness (CE) of regorafenib dose optimization schedule in metastatic colorectal cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18367-e18367
Author(s):  
Afsaneh Barzi ◽  
Sang K Cho ◽  
Joel W Hay ◽  
Heinz-Josef Lenz ◽  
Fang-Shu Ou ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Willingness To Pay ◽  
Metastatic Colorectal Cancer ◽  
Dose Optimization ◽  
Weekly Dose ◽  
The Cost ◽  
The Impact ◽  
Quality Adjusted Life

e18367 Background: Regorafenib at 160mg daily 21/28 days is a standard therapeutic option in patients with metastatic colorectal cancer. However, the cost of treatment and management of its side-effects is more than the cost-effectiveness threshold for oncology drugs in US and many countries around the world. ReDOS (Regorafenib Dose Optimization Study), is a randomized phase II trial in refractory mCRC and established that weekly dose escalation of regorafenib over the conventional dosing is superior in the composite endpoint of safety and efficacy. We explored the impact of the new dosing strategy on CE of regorafenib. Methods: A Markov model was constructed to compare costs and effectiveness of regorafenib (standard), regorafenib (ReDOS), and best supportive care (BSC). Model inputs for clinical efficacy and safety were from the CORRECT trial for regorafenib (standard) and BSC, and the ReDOS study for regorafenib (ReDOS). The incremental cost-effectiveness ratios (ICERs) were reported to compare treatments. Model robustness was checked with univariate and probabilistic sensitivity analyses. The model used a US payer’s perspective with 5% annual discount rate, and all costs were measured in 2018 US dollars. Results: Regorafenib (ReDOS) dominated regorafenib (standard), producing higher quality-adjusted life years at a lower cost. When compared to BSC, regorafenib (ReDOS) resulted in the ICER of $112,705 while regorafenib (standard) resulted in the ICER of $384,687. The most influential parameters on the ICERs were efficacy and health state utility parameters under univariate sensitivity analysis. In probabilistic sensitivity analysis using cost-effectiveness acceptability curves, regorafenib (ReDOS) was more cost-effective than regorafenib (standard) and BSC in 70% of repetition at the willingness-to-pay threshold of $120,000 per QALY (Quality-Adjusted Life Year) and 98% at a WTP threshold of $150,000. Conclusions: Based on the outcomes demonstrated in the ReDOS study, the dose optimization strategy of regorafenib results in favorable cost-effectiveness under a typical US willingness-to-pay threshold of $150,000 per QALY.

scholarly journals Cost-Effectiveness Analysis of Regorafenib for Metastatic Colorectal Cancer

2015 ◽  
Vol 33 (32) ◽  
pp. 3727-3732 ◽  
Author(s):  
Daniel A. Goldstein ◽  
Bilal B. Ahmad ◽  
Qiushi Chen ◽  
Turgay Ayer ◽  
David H. Howard ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Metastatic Colorectal Cancer ◽  
Sensitivity Analyses ◽  
Cost Effectiveness Ratio ◽  
The Third ◽  
Life Years ◽  
Third Line ◽  
The Cost

Purpose Regorafenib is a standard-care option for treatment-refractory metastatic colorectal cancer that increases median overall survival by 6 weeks compared with placebo. Given this small incremental clinical benefit, we evaluated the cost-effectiveness of regorafenib in the third-line setting for patients with metastatic colorectal cancer from the US payer perspective. Methods We developed a Markov model to compare the cost and effectiveness of regorafenib with those of placebo in the third-line treatment of metastatic colorectal cancer. Health outcomes were measured in life-years and quality-adjusted life-years (QALYs). Drug costs were based on Medicare reimbursement rates in 2014. Model robustness was addressed in univariable and probabilistic sensitivity analyses. Results Regorafenib provided an additional 0.04 QALYs (0.13 life-years) at a cost of $40,000, resulting in an incremental cost-effectiveness ratio of $900,000 per QALY. The incremental cost-effectiveness ratio for regorafenib was > $550,000 per QALY in all of our univariable and probabilistic sensitivity analyses. Conclusion Regorafenib provides minimal incremental benefit at high incremental cost per QALY in the third-line management of metastatic colorectal cancer. The cost-effectiveness of regorafenib could be improved by the use of value-based pricing.

Cost-effectiveness of biomarker-directed bevacizumab for first-line therapy of persons with metastatic colorectal cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6077-6077
Author(s):  
Kristin Berry ◽  
Mark Eliot Bensink ◽  
Zahra Musa ◽  
Veena Shankaran ◽  
Edward H. Lin ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cost Effectiveness ◽  
Metastatic Colorectal Cancer ◽  
Cost Savings ◽  
Predictive Test ◽  
Quality Adjusted Life Years ◽  
First Line ◽  
Life Years ◽  
The Cost ◽  
Quality Adjusted Life

6077 Background: When added to first-line chemotherapy for metastatic colorectal cancer, bevacizumab provides a moderate survival increase, but is associated with significant adverse events and high cost. As only a minority of patients respond to antiangiogenic therapy, a diagnostic that identifies potential responders ex ante could potentially change the benefit to risk profile of bevacizumab and likely improve cost-effectiveness. Since efforts to identify a predictive test have so far been unsuccessful, a novel strategy may be to measure tumor response after bevacizumab treatment initiation using an in vivo biomarker test to guide decisions on whether patients should continue treatment. The objective is to estimate the cost-effectiveness of biomarker-directed use of bevacizumab in first-line treatment of metastatic colorectal cancer compared to standard care. Methods: The analysis takes the perspective of the US healthcare system. A decision model was built to estimate the incremental effect of adding bevacizumab to IFL, FOLFIRI, 5FU/LV and FOLOFOX/XELOX regimens. Survival data, estimated through a meta-analysis of four clinical trials, combined with utilities from the literature were used to calculate quality-adjusted life years (QALYs). Costs were based on Medicare reimbursement and expert opinion. Assumed performance characteristics of the biomarker technology (sensitivity, specificity – provided by our industry partner) were 75% and 95% 10 days after commencement of bevacizumab. Results: The biomarker-directed bevacizumab strategy dominated usual care, providing both an average per patient gain of 0.015 QALYs and a cost-savings of $21,038. The cost-effectiveness of the biomarker technology was most influenced by the cost of the test and colorectal cancer utilities. Variations in biomarker specificity and sensitivity changed the magnitude of cost-savings and benefit gain but did not change the overall result of dominance. Conclusions: Modeling predicts that a validated marker which could identify responders to bevacizumab will save money and improve quality-adjusted life years. The results support additional investment in identifying such a diagnostic.

scholarly journals Cost-effectiveness of TAS-102 plus bevacizumab versus TAS-102 monotherapy in patients with metastatic colorectal cancer

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kiyoaki Sugiura ◽  
Yuki Seo ◽  
Takayuki Takahashi ◽  
Hideyuki Tokura ◽  
Yasuhiro Ito ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Combination Therapy ◽  
Metastatic Colorectal Cancer ◽  
Cost Effective ◽  
Model Parameters ◽  
Combination Regimen ◽  
The Cost

Abstract Background TAS-102 plus bevacizumab is an anticipated combination regimen for patients who have metastatic colorectal cancer. However, evidence supporting its use for this indication is limited. We compared the cost-effectiveness of TAS-102 plus bevacizumab combination therapy with TAS-102 monotherapy for patients with chemorefractory metastatic colorectal cancer. Method Markov decision modeling using treatment costs, disease-free survival, and overall survival was performed to examine the cost-effectiveness of TAS-102 plus bevacizumab combination therapy and TAS-102 monotherapy. The Japanese health care payer’s perspective was adopted. The outcomes were modeled on the basis of published literature. The incremental cost-effectiveness ratio (ICER) between the two treatment regimens was the primary outcome. Sensitivity analysis was performed and the effect of uncertainty on the model parameters were investigated. Results TAS-102 plus bevacizumab had an ICER of $21,534 per quality-adjusted life-year (QALY) gained compared with TAS-102 monotherapy. Sensitivity analysis demonstrated that TAS-102 monotherapy was more cost-effective than TAS-102 and bevacizumab combination therapy at a willingness-to-pay of under $50,000 per QALY gained. Conclusions TAS-102 and bevacizumab combination therapy is a cost-effective option for patients who have metastatic colorectal cancer in the Japanese health care system.

scholarly journals Cost-Effectiveness Analysis Comparing Two Approaches for Empirical Antifungal Therapy in Hematological Patients with Persistent Febrile Neutropenia

2013 ◽  
Vol 57 (10) ◽  
pp. 4664-4672 ◽  
Author(s):  
Almudena Martín-Peña ◽  
M. Victoria Gil-Navarro ◽  
Manuela Aguilar-Guisado ◽  
Ildefonso Espigado ◽  
Maite Ruiz Pérez de Pipaón ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Febrile Neutropenia ◽  
Antifungal Therapy ◽  
Standard Approach ◽  
Sensitivity Analyses ◽  
Treatment Pathways ◽  
Hematological Patients ◽  
Wide Range ◽  
Empirical Antifungal Therapy ◽  
The Cost

ABSTRACTNew approaches of empirical antifungal therapy (EAT) in selected hematological patients with persistent febrile neutropenia (PFN) have been proposed in recent years, but their cost-effectiveness has not been studied. The aim of this study was to compare the cost-effectiveness of two different approaches of EAT in hematological patients with PFN: the diagnosis-driven antifungal therapy (DDAT) approach versus the standard approach of EAT. A decision tree to assess the cost-effectiveness of both approaches was developed. Outcome probabilities and treatment pathways were extrapolated from two studies: a prospective cohort study following the DDAT approach and a randomized clinical trial following the standard approach. Uncertainty was undertaken through sensitivity analyses and Monte Carlo simulation. The average effectiveness and economic advantages in the DDAT approach compared to the standard approach were 2.6% and €5,879 (33%) per PFN episode, respectively. The DDAT was the dominant approach in the 99.5% of the simulations performed with average cost-effectiveness per PFN episode of €32,671 versus €52,479 in the EAT approach. The results were robust over a wide range of variables. The DDAT approach is more cost-effective than the EAT approach in the management of PFN in hematological patients.

scholarly journals Cost-Effectiveness of UGT1A1*28 Genotyping in Preventing Severe Neutropenia Following FOLFIRI Therapy in Colorectal Cancer.

2011 ◽  
Vol 13 (4) ◽  
pp. 615 ◽  
Author(s):  
Solen Pichereau ◽  
Anne Le Louarn ◽  
Thierry Lecomte ◽  
Hélène Blasco ◽  
Chantal Le Guellec ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Febrile Neutropenia ◽  
Metastatic Colorectal Cancer ◽  
Severe Neutropenia ◽  
Functional Polymorphisms ◽  
The Cost ◽  
Genotype Screening ◽  
Ugt1a1 Genotype

PURPOSE: Functional polymorphisms of the UGT1A1 gene, particularly the UGT1A1*28 variant, are associated with the severity of the bone marrow suppression in patients with metastatic colorectal cancer receiving irinotecan. This study assesses the cost-effectiveness of screening for UGT1A1*28 polymorphism associated with primary prophylactic Granulocytes Colony Stimulating Factor in patients homozygous for the *28 allele. The effectiveness was estimated based on the number of neutropenia avoided. METHODS: We modelled a theoretical population treated with combined 5-fluorouracil, leucovorin and irinotecan (FOLFIRI) for metastatic colorectal cancer. A decision tree simulated the health outcomes, measured by the prevalence of neutropenic events for two strategies, with or without UGT1A1 genotype screening. The model incorporated direct hospital costs and was validated with a sensitivity analysis. We calculated the cost-effectiveness ratio: CE=∆C / ∆E = "genotyping" cost – "no genotyping" cost / number of febrile neutropenia avoided. RESULTS: In the "genotyping strategy", the cost to avoid one febrile neutropenia event per 1000 patients treated was € 942.8 to € 1090.1. The sensitivity analysis showed a better CE ratio of € 733.4 to € 726.6 per febrile neutropenic event avoided.CONCLUSIONS: UGT1A1 genotype screening before irinotecan treatment is a cost-efficient strategy for the hospital. Systematic genotyping prior to chemotherapy, and administration of CSF in patients homozygotes for the *28 allele allow to avoid 91 febrile neutropenias at an acceptable cost.

Cost-effectiveness of regorafenib for pretreated metastatic colorectal cancer patients in the United States.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 578-578 ◽  
Author(s):  
Brian S. Seal ◽  
Ipek Özer-Stillman ◽  
John Whalen ◽  
Apoorva Ambavane ◽  
Avin Yaldo ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Adverse Event ◽  
Cost Effectiveness ◽  
Metastatic Colorectal Cancer ◽  
Unmet Need ◽  
Drug Acquisition ◽  
Trial Data ◽  
Administrative Claims ◽  
Heavily Pretreated ◽  
The Cost

578 Background: There is an unmet need for treatments that provide a survival benefit for patients with heavily pretreated metastatic colorectal cancer (mCRC). In a randomized, double-blind, placebo-controlled trial, patients treated with regorafenib plus best supportive care (BSC) had significant improvement in overall survival (OS) versus patients in the placebo arm receiving BSC alone. The aim of this study was to estimate the cost-effectiveness of regorafenib for the treatment of patients with mCRC after failure or intolerance to irinotecan-, oxaliplatin-, and fluorouracil-based regimens, from the perspective of a U.S. health care payer. Methods: A cohort-partition model was developed to simulate treatment costs and survival for patients treated with regorafenib or BSC alone. Survival was projected by fitting Weibull distributions to trial data. Mean duration of treatment (3.0 months regorafenib, 2.1 months BSC), utilities (0.71 on treatment, 0.59 post-treatment) and serious adverse event rates were also based on trial data. Monthly drug monitoring and physician fee costs were based on Medicare fee schedules. Routine mCRC care and adverse event unit costs were obtained from an analysis of administrative claims in two large managed care databases. Costs were estimated in 2012 USD. Results: Patients treated with regorafenib had prolonged survival versus BSC alone (0.75 versus 0.60 years) and also had higher lifetime costs ($97,700 versus $59,494). The improvement in quality-adjusted life years (0.47 versus 0.37) was small due to the heavily pretreated nature of the patient population. The increase in costs was attributable to increases in costs for drug acquisition, adverse events , and routine care from increased survival. Conclusions: Regorafenib increases life expectancy for patients with pretreated metastatic colorectal cancer. The cost of this benefit could be considered high; however, it could be justifiable given high unmet need for these patients. The increase in cost is primarily due to drug acquisition costs, similar to other recent treatments for metastatic cancers.

Bevacizumab in addition to chemotherapy first-line for right-side metastatic colorectal cancer: A cost-effectiveness analysis.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 777-777
Author(s):  
Gong Chen ◽  
Maobai Liu ◽  
Te Li ◽  
Bin Wu
Keyword(s):  
Colorectal Cancer ◽  
Cost Effectiveness ◽  
Metastatic Colorectal Cancer ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
First Line ◽  
Assistance Program ◽  
Scenario Analyses ◽  
Bevacizumab Treatment ◽  
The Impact

777 Background: To test the cost-effectiveness of bevacizumab treatment compared with cetuximab plus irinotecan, fluorouracil, and leucovorin (FOLFIRI) as first-line treatment for patients with right-side metastatic colorectal cancer (mCRC). Methods: A Markov model was developed to Chinese clinical practice. The model incorporated clinical and utility data from published literatures, resource utilization and unit prices based on local charge. The lifetime horizontal was used and sensitivity analyses were carried out to test the robustness of the model results. The impact of patient assistance program (PAP) was also evaluated in scenario analyses. Results: Baseline analysis showed that the addition of cetuximab gained additional 0.232 QALYs with more $60,371 relative to bevacizumab therapy, resulting in an ICER of $259,775 /QALY. When PAP was available, the incremental cost decreased to $24,161, which yielded an ICER of $60,371 /QALY, which indicated that the strategy was not cost-effective at a willingness-to-pay (WTP) threshold of 3 times the per capita GDP of China ($22,200/QALY). Sensitivity analyses found that the costs of bevacizumab was the most influential parameter. Conclusions: Bevacizumab treatment for right-side mCRC is not a cost-effective option in comparison with standard chemotherapy in Chinese context.

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