Xu Yifan, Hay Joel W, Barzi Afsaneh
1Schaeffer Center for Health Policy and Economics, University of Southern California, 635 Downey Way, Suite 310, Los Angeles, CA 90089 USA.
2Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Ave. Suite 3440, Los Angeles, CA 90033 USA.
Cost Eff Resour Alloc. 2018 Nov 12;16:30. doi: 10.1186/s12962-018-0132-9. eCollection 2018.
The alarming increase in the cost of cancer care is forcing all stakeholders to re-evaluate their approach to treatment. Drugs are the main contributor to the cost. To evaluate the significance of drug substitution on the cost of care we assessed the economic value of panitumumab vs. cetuximab in chemo-refractory metastatic CRC (mCRC) with wild-type KRAS from a US societal perspective.
We developed a Markov model with three health states: progression-free, progressive, and death. We calculated the transition probabilities between states using the ASPECCT trial report and US life tables. Costs of drug and administration were based on the Medicare reimbursement rates. Published data were used for cost of toxicities and utilities. All costs were converted to 2017 US dollars. The model used quality-adjusted life-years (QALYs) to measure health outcomes for each treatment option.
Panitumumab and cetuximab produced 0.45 QALYs at a per patient cost of $66,006 and $71,956, respectively. The incremental net monetary benefit of panitumumab compared to cetuximab is $5237 under a societal willingness-to-pay threshold of $150,000. The model showed robustness to one-way sensitivity analyses and various alternative scenarios and was found to be most sensitive to the cost of cetuximab.
Panitumumab can lower the cost of care without impacting outcomes in chemo-refractory mCRC settings. This finding provides a strong argument to consider panitumumab in lieu of cetuximab in these patients.
癌症治疗费用的惊人增长迫使所有利益相关者重新评估其治疗方法。药物是成本的主要贡献因素。为了评估药物替代对护理成本的重要性，我们从美国社会角度评估了帕尼单抗与西妥昔单抗在野生型KRAS的化疗难治性转移性结直肠癌（mCRC）中的经济价值。
我们开发了一个具有三种健康状态的马尔可夫模型：无进展、进展和死亡。我们使用ASPECCT试验报告和美国生命表计算状态之间的转移概率。药物和给药成本基于医疗保险报销率。已发表的数据用于毒性成本和效用。所有成本均换算为2017年美元。该模型使用质量调整生命年（QALY）来衡量每种治疗方案的健康结果。
帕尼单抗和西妥昔单抗分别产生0.45个QALY，每位患者的成本分别为66,006美元和71,956美元。在社会支付意愿阈值为150,000美元的情况下，帕尼单抗与西妥昔单抗相比的增量净货币效益为5237美元。该模型对单向敏感性分析和各种替代方案显示出稳健性，并且发现对西妥昔单抗的成本最为敏感。
在化疗难治性mCRC环境中，帕尼单抗可以降低护理成本而不影响结果。这一发现为在这些患者中考虑使用帕尼单抗代替西妥昔单抗提供了有力论据。
