Capecitabine/oxaliplatin (XELOX) versus XELOX plus bevacizumab (XELOX + bev) cost-effectiveness for metastatic colorectal cancer (mCRC) in first line treatment: a Brazilian public hospital analysis

Abstract

Background: In the last decade there has been a significant improvement in response rates, progression-free survival and overall survival in metastatic colorectal cancer, a result of the development of new standard chemotherapy combinations and appearance of target-specific drugs, such as bevacizumab. Given the high cost of this therapy and since the resources available for health care are increasingly limited, this study aimed to carry out a cost-effectiveness analysis of XELOX protocol plus bevacizumab in first line treatment for patients with metastatic colorectal cancer from the perspective of a public hospital focused on care and education. Methods: The economic assessment employed a simple decision associated with Markov model, where costs are expressed in local currency (R$) and outcomes in months of life gained (MVG). This model used the TreeAge Pro 2013® software. It has crafted a model of Markov state transition in time horizon of 60 months, each model cycle corresponded to three months. The cost Da ta were collected retrospectively by micro-costing, and obtained through the internal electronic Da ta system of Clinical Oncology Division. Results: The Da ta effectiveness and the transition probabilities between the states health were calculated using Da ta from clinical studies selected by systematic review. The difference improvement in months of life gained was 2.25 for an extra cost of R$ 47,833.57, which resulted in an increased cost-effectiveness ratio of R$ 21,231.43 per month gain life. In the sensitivity analysis, the variable that had the greatest impact was the effectiveness for clinical support health in XELOX. When this parameter was inserted in the model with the minimum value, the cost-effectiveness ratio increased R $ 7,814.47 and based on the maximum value that was for R$-29,614.12, meaning that in this scenario the XELOX + Bev has become dominated by XELOX. Conclusions: Considering the World Health Organization cost-effectiveness threshold (three times the value of GDP per capita), the XELOX + bev protocol it was not considered cost-effective.