Graham Christopher N, Hechmati Guy, Hjelmgren Jonas, de Liège Frédérique, Lanier Julie, Knox Hediyyih, Barber Beth
RTI Health Solutions, 200 Park Offices Drive, Research Triangle Park, NC, USA.
Global Health Economics, Amgen (Europe) GmbH, Dammstrasse 23, Zug, Switzerland.
Eur J Cancer. 2014 Nov;50(16):2791-801. doi: 10.1016/j.ejca.2014.08.016. Epub 2014 Sep 15.
To investigate the cost-effectiveness of panitumumab plus mFOLFOX6 (oxaliplatin, 5-fluorouracil and leucovorin) compared with bevacizumab plus mFOLFOX6 in first-line treatment of patients with wild-type RAS metastatic colorectal cancer (mCRC).
A semi-Markov model was constructed from a French health collective perspective, with health states related to first-line treatment (progression-free), disease progression with and without subsequent active treatment, resection of metastases, disease-free after successful resection and death.
Parametric survival analyses of patient-level progression-free and overall survival data from the only head-to-head clinical trial of panitumumab and bevacizumab (PEAK) were performed to estimate transitions to disease progression and death. Additional data from PEAK informed the amount of each drug consumed, duration of therapy, subsequent therapy use, and toxicities related to mCRC treatment. Literature and French public data sources were used to estimate unit costs associated with treatment and duration of subsequent active therapies. Utility weights were calculated from patient-level data from panitumumab trials in the first-, second- and third-line settings. A life-time perspective was applied. Scenario, one-way, and probabilistic sensitivity analyses were performed.
Based on a head-to-head clinical trial that demonstrates better efficacy outcomes for patients with wild-type RAS mCRC who receive panitumumab plus mFOLFOX6 versus bevacizumab plus mFOLFOX6, the incremental cost per life-year gained was estimated to be €26,918, and the incremental cost per quality-adjusted life year (QALY) gained was estimated to be €36,577. Sensitivity analyses indicate the model is robust to alternative parameters and assumptions.
The incremental cost per QALY gained indicates that panitumumab plus mFOLFOX6 represents good value for money in comparison to bevacizumab plus mFOLFOX6 and, with a willingness-to-pay ranging from €40,000 to €60,000, can be considered cost-effective in first-line treatment of patients with wild-type RAS mCRC.
研究帕尼单抗联合mFOLFOX6（奥沙利铂、5-氟尿嘧啶和亚叶酸钙）与贝伐单抗联合mFOLFOX6用于一线治疗野生型RAS转移性结直肠癌（mCRC）患者的成本效益。
从法国卫生保健体系角度构建半马尔可夫模型，健康状态与一线治疗（无进展）、有或无后续积极治疗的疾病进展、转移灶切除、成功切除后的无病状态及死亡相关。
对帕尼单抗和贝伐单抗唯一的头对头临床试验（PEAK）中患者水平的无进展生存期和总生存期数据进行参数生存分析，以估计疾病进展和死亡的转变情况。PEAK的其他数据提供了每种药物的消耗量、治疗持续时间、后续治疗的使用情况以及与mCRC治疗相关的毒性。利用文献和法国公共数据源估计与治疗及后续积极治疗持续时间相关的单位成本。从帕尼单抗一线、二线和三线治疗试验的患者水平数据计算效用权重。采用终身视角。进行情景分析、单因素敏感性分析和概率敏感性分析。
基于一项头对头临床试验，该试验表明接受帕尼单抗联合mFOLFOX6的野生型RAS mCRC患者比接受贝伐单抗联合mFOLFOX6的患者有更好的疗效，估计每获得一个生命年的增量成本为26,918欧元，每获得一个质量调整生命年（QALY）的增量成本为36,577欧元。敏感性分析表明该模型对替代参数和假设具有稳健性。
每获得一个QALY的增量成本表明，与贝伐单抗联合mFOLFOX6相比，帕尼单抗联合mFOLFOX6具有良好的性价比，对于支付意愿在40,000欧元至60,000欧元之间的患者，在一线治疗野生型RAS mCRC时可被认为具有成本效益。
