P-233 Economic impact of biomarker-based anti EGFR therapies in metastatic colorectal cancer in Austria

Abstract

Introduction: As the third most common type of cancer in the world, colorectal cancer is a burden to mankind. It is also a burden to the health-care system ranked on the second place in the national cancer care costs in the US. Due to multimodal therapy options including monoclonal antibodies, median survival in metastatic disease improved by more than two years within the last decade. The aim of our investigation was to exemplify the cost impact of using predictive biomarker scenarios for patient pre-selection to guide systemic anti- Epidermal Growth Factor Receptor (EGFR) treatment in metastatic colorectal cancer (mCRC) in Austria. Methods: We performed an economic analysis including a cost-effectiveness analysis (CEA) for the combination of EGFR inhibitors (cetuximab or panitumumab) with standard chemotherapy (FOLFOX, FOLFIRI) in the first line treatment of mCRC. The calculations (treatment duration, days of hospitalization and visits for side effects) were based on real-life data of 47 patients. An analysis for the various marker scenarios was used to estimate the incremental cost-effectiveness ratio between marker testing and no testing at all. Clinical outcome inputs were taken from published studies with a level of evidence 1. Calculations were based on country specific direct costs (in Euro, year 2013). Setting: One private and one public oncological department in Austria. Results: On an average single patient basis, simple KRAS testing amounts to a minimum saving ofmore than 1.100 EUR per month, which can be increased with all RAS family members testing up to 1.800 EUR permonth. In Austria, with an incidence of 1100 patients per year, cost reductions up to 16, 25 or even 34% could be reached when using biomarkers with higher selection accuracy. Based on available efficacy data the incremental cost per life year gained was estimated to be 26.276 EUR for the KRAS scenario (selection accuracy: 35%), 9.686 EUR for the all RAS scenario (selection accuracy: 55%) and 3.948 EUR for a future but achievable biomarker scenario (selection accuracy: 75%). Conclusion: This, testing predictive biomarkers is cost saving in the therapy of mCRC. Given the substantial financial relief for the healthcare system, research aimed at implementation of these biomarkers in the clinical setting should therefore be given highest priority and the required resources.