Zhou Jing, Zhao Rongce, Wen Feng, Zhang Pengfei, Tang Ruilei, Chen Hongdou, Zhang Jian, Li Qiu
Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy Division of Liver Transplantation, Department of Liver Surgery, West China Hospital, Sichuan University, China.
Medicine (Baltimore). 2016 Jul;95(27):e3762. doi: 10.1097/MD.0000000000003762.
Cetuximab (Cetux)/Bevacizumab (Bev) treatments have shown considerably survival benefits for patients with metastatic colorectal cancer (mCRC) in the last decade. But they are costly. Currently, no data is available on the health economic implications of testing for extended RAS wild-type (wt) prior to Cetux/Bev treatments of patients with mCRC. This paper aimed to evaluate the cost-effectiveness of predictive testing for extended RAS-wt status in mCRC in the context of targeting the use of Cetux/Bev.Markov model 1 was conducted to provide evidence evaluating the cost-effectiveness of predictive testing for KRAS-wt or extended RAS-wt status based on treatments of chemotherapy plus Cetux/Bev. Markov model 2 assessed the cost-effectiveness of FOLFOX plus Cetux/Bev or FOLFIRI plus Cetux/Bev in extended RAS-wt population. Primary base case data were identified from the CALGB 80405 trial and the literatures. Costs were estimated from West China Hospital, Sichuan University, China. Survival benefits were reported in quality-adjusted life-years (QALYs). The incremental cost-effectiveness ratio (ICER) was calculated.In analysis 1, the cost per QALY was $88,394.09 for KRAS-Cetux, $80,797.82 for KRAS-Bev, $82,590.72 for RAS-Cetux, and $75,358.42 for RAS-Bev. The ICER for RAS-Cetux versus RAS-Bev was $420,700.50 per QALY gained. In analysis 2, the cost per QALY was $81,572.61, $80,856.50, $80,592.22, and $66,794.96 for FOLFOX-Cetux, FOLFOX-Bev, FOLFIRI-Cetux, and FOLFIRI-Bev, respectively. The analyses showed that the extended RAS-wt testing was less costly and more effective versus KRAS-wt testing before chemotherapy plus Cetux/Bev. Furthermore, FOLFIRI plus Bev was the most cost-effective strategy compared with others in extended RAS-wt population.It was economically favorable to identify patients with extended RAS-wt status. Furthermore, FOLFIRI plus Bev was the preferred strategy in extended RAS-wt patients.
在过去十年中，西妥昔单抗（Cetux）/贝伐单抗（Bev）治疗已显示出对转移性结直肠癌（mCRC）患者有显著的生存益处。但它们成本高昂。目前，关于在mCRC患者接受Cetux/Bev治疗前检测扩展RAS野生型（wt）的健康经济影响尚无数据。本文旨在评估在靶向使用Cetux/Bev的背景下，对mCRC患者扩展RAS-wt状态进行预测性检测的成本效益。
进行马尔可夫模型1以提供证据，评估基于化疗加Cetux/Bev治疗对KRAS-wt或扩展RAS-wt状态进行预测性检测的成本效益。马尔可夫模型2评估了在扩展RAS-wt人群中FOLFOX加Cetux/Bev或FOLFIRI加Cetux/Bev的成本效益。主要基础病例数据来自CALGB 80405试验和文献。成本由中国四川大学华西医院估算。生存益处以质量调整生命年（QALYs）报告。计算增量成本效益比（ICER）。
在分析1中，KRAS-Cetux每获得一个QALY的成本为88,394.09美元，KRAS-Bev为80,797.82美元，RAS-Cetux为82,590.72美元，RAS-Bev为75,358.42美元。RAS-Cetux与RAS-Bev相比，每获得一个QALY的ICER为420,700.50美元。在分析2中，FOLFOX-Cetux、FOLFOX-Bev、FOLFIRI-Cetux和FOLFIRI-Bev每获得一个QALY的成本分别为81,572.61美元、80,856.50美元、80,592.22美元和66,794.96美元。分析表明，与化疗加Cetux/Bev前进行KRAS-wt检测相比，扩展RAS-wt检测成本更低且更有效。此外，在扩展RAS-wt人群中，FOLFIRI加Bev是与其他方案相比最具成本效益的策略。
识别扩展RAS-wt状态的患者在经济上是有利的。此外，FOLFIRI加Bev是扩展RAS-wt患者的首选策略。
