Cost-effectiveness analysis of panitumumab plus mFOLFOX6 Compared to Bevacizumab Plus mFOLFOX6 for first-line treatment of patients with wild-type RAS metastatic colorectal cancer - Czech Republic model adaptation

Abstract

Background: Pharmacoeconomic assessments are a part of the decision process not only during reimbursement setting, but in clinical practice as well. The presented cost-effectiveness analysis assesses panitumumab + mFOLFOX6 vs. bevacizumab + mFOLFOX6 in 1st line treatment of patients with wild-type RAS metastatic colorectal cancer (mCRC) in the Czech environment. Material and Methods: The adaptation of a Markov model considers the health-care perspective; clinical data (efficacy, health-care utilization and adverse events) are derived from a head-to-head comparison (PEAK study). Health states included in the model: progression free on treatment, progression (with/without active treatment), resection of metastases, disease-free after successful resection and death. Actual reimbursement levels were used to estimate costs, published literature to estimate duration of 2nd line treatment. The analysis assumes a life-time horizon; uncertainty was limited by performing one-way and probabilistic sensitivity analyses. Analysis outcomes are life-years gained (LYG) and quality-adjusted life-years (QALYs). Results: Panitumumab + mFOLFOX6 is more effective and more costly in 1st line patients with wild-type RAS mCRC. Incremental costs per QALY are 837,270 CZK, per LYG 615,022 CZK; however, below the willingness-to-pay threshold applied in the Czech Republic. Conclusions: Panitumumab + mFOLFOX6 is cost-effective in 1st line treatment of patients with wild-type RAS mCRC compared to bevacizumab + mFOLFOX6 in the Czech setting.