Economic analysis of the first-line treatment with cetuximab or panitumumab for RAS wild-type metastatic colorectal cancer in England

Irina A. Tikhonova, Nicola Huxley, Tristan Snowsill, Louise Crathorne, Jo Varley-Campbell, Mark Napier, Martin Hoyle

Research output: Contribution to journalArticleResearchpeer-review

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.
LanguageEnglish
Pages837-851
Number of pages15
JournalPharmacoEconomics
Volume36
Issue number7
DOIs
Publication statusPublished - Jul 2018
Externally publishedYes

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oxaliplatin
Leucovorin
irinotecan
Fluorouracil
Sarcoma
England
Colorectal Neoplasms
Economics
National Institutes of Health (U.S.)
Cost-Benefit Analysis
Pharmaceutical Preparations
Quality-Adjusted Life Years
National Health Programs
Delivery of Health Care
Therapeutics
Costs and Cost Analysis
Liver
panitumumab
Cetuximab
Social Work

Cite this

Tikhonova, Irina A. ; Huxley, Nicola ; Snowsill, Tristan ; Crathorne, Louise ; Varley-Campbell, Jo ; Napier, Mark ; Hoyle, Martin. / Economic analysis of the first-line treatment with cetuximab or panitumumab for RAS wild-type metastatic colorectal cancer in England. In: PharmacoEconomics. 2018 ; Vol. 36, No. 7. pp. 837-851.
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title = "Economic analysis of the first-line treatment with cetuximab or panitumumab for RAS wild-type metastatic colorectal cancer in England",
abstract = "Background: Combination therapies with cetuximab (Erbitux{\circledR}; Merck Serono UK Ltd) and panitumumab (Vectibix{\circledR}; 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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Economic analysis of the first-line treatment with cetuximab or panitumumab for RAS wild-type metastatic colorectal cancer in England. / Tikhonova, Irina A.; Huxley, Nicola; Snowsill, Tristan; Crathorne, Louise; Varley-Campbell, Jo; Napier, Mark; Hoyle, Martin.

In: PharmacoEconomics, Vol. 36, No. 7, 07.2018, p. 837-851.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Economic analysis of the first-line treatment with cetuximab or panitumumab for RAS wild-type metastatic colorectal cancer in England

AU - Tikhonova, Irina A.

AU - Huxley, Nicola

AU - Snowsill, Tristan

AU - Crathorne, Louise

AU - Varley-Campbell, Jo

AU - Napier, Mark

AU - Hoyle, Martin

PY - 2018/7

Y1 - 2018/7

N2 - 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.

AB - 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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U2 - 10.1007/s40273-018-0630-9

DO - 10.1007/s40273-018-0630-9

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