Pettigrew M, Kavan P, Surprenant L, Lim H J
a a Symbiose Partenariat Strategique Inc , Montreal , Quebec , Canada.
b b Jewish General Hospital , Oncology , Montreal , Quebec , Canada.
J Med Econ. 2016;19(2):135-47. doi: 10.3111/13696998.2015.1105230. Epub 2015 Nov 11.
Clinical practice guidelines support the use of the epidermal growth factor receptor (EGFR) inhibitors panitumumab and cetuximab for the treatment of metastatic colorectal cancer (mCRC) after failure of other chemotherapy regimens, based on significant clinical benefits in patients with wild-type KRAS. The purpose of the analysis was to compare provincial hospital costs when using panitumumab vs cetuximab with or without irinotecan in this patient population using a Net Impact Analysis (NIA) approach.
The NIA determined the total per patient cost of the reimbursed regimens of panitumumab vs cetuximab in British Columbia, Alberta, Manitoba, Ontario, and Québec. Utilization of healthcare resources related to EGFR inhibitor infusions, follow-up monitoring, and treatment of adverse events (AEs) were also included. Healthcare resource use including drugs, medical supplies, laboratory testing, oncology infusion time, and healthcare professionals' time was obtained through expert consultation and the use was then multiplied by the province-specific cost of each resource. Numerous sensitivity analyses were conducted.
Based on the dosing regimens in place in each province, the total annual per patient cost of panitumumab ranged from $22,203-$32,600, while the total annual per patient cost of cetuximab treatment varied from $30,321-$40,908. Treatment with panitumumab resulted in lower costs in all cost categories including drug acquisition, infusion preparation/administration, patient monitoring, and AE management. Per patient savings with panitumumab ranged from a low of $3815 in British Columbia to a high of $10,603 in Ontario. In sensitivity analyses, panitumumab remained cost saving in all scenarios where the savings ranged from $150-$16,006 per patient.
Treating chemorefractory mCRC patients with panitumumab rather than cetuximab reduced healthcare resource costs. Provincial healthcare savings achieved with the use of panitumumab could potentially be re-allocated to other cancer treatments, although further study would be needed to validate this assumption.
临床实践指南支持在其他化疗方案失败后，基于对野生型KRAS患者具有显著临床益处，使用表皮生长因子受体（EGFR）抑制剂帕尼单抗和西妥昔单抗治疗转移性结直肠癌（mCRC）。本分析的目的是采用净影响分析（NIA）方法，比较在该患者群体中使用帕尼单抗与西妥昔单抗联合或不联合伊立替康时省级医院的费用。
NIA确定了不列颠哥伦比亚省、艾伯塔省、曼尼托巴省、安大略省和魁北克省帕尼单抗与西妥昔单抗报销方案的每位患者总费用。还纳入了与EGFR抑制剂输注、随访监测及不良事件（AE）治疗相关的医疗资源利用情况。通过专家咨询获取包括药物、医疗用品、实验室检测、肿瘤输注时间及医疗专业人员时间在内的医疗资源使用情况，然后将其使用量乘以每个省份特定资源的成本。进行了多次敏感性分析。
根据每个省份的给药方案，帕尼单抗每位患者每年的总费用在22,203美元至32,600美元之间，而西妥昔单抗治疗每位患者每年的总费用在30,321美元至40,908美元之间。使用帕尼单抗治疗在所有成本类别中均导致费用降低，包括药物采购、输注准备/给药、患者监测及AE管理。使用帕尼单抗每位患者节省的费用从不列颠哥伦比亚省的低至3815美元到安大略省的高至10,603美元不等。在敏感性分析中，在所有情况下帕尼单抗均节省成本，每位患者节省的费用在150美元至16,006美元之间。
用帕尼单抗而非西妥昔单抗治疗化疗难治性mCRC患者可降低医疗资源成本。使用帕尼单抗实现的省级医疗费用节省可能会重新分配用于其他癌症治疗，不过需要进一步研究来验证这一假设。
