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Pataky RE, Beca J, Tran D, Dai WF, Dvorani E, Isaranuwatchai W, Peacock S, Alvi R, Cheung WY, Earle CC, Gavura S, Chan KKW. Real-World Cost-Effectiveness of Bevacizumab With First-Line Combination Chemotherapy in Patients With Metastatic Colorectal Cancer: Population-Based Retrospective Cohort Studies in Three Canadian Provinces. MDM Policy Pract 2021; 6:23814683211021060. [PMID: 34212111 PMCID: PMC8216386 DOI: 10.1177/23814683211021060] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 05/03/2021] [Indexed: 11/16/2022] Open
Abstract
Background. Real-world evidence can be a valuable tool when clinical trial data are incomplete or uncertain. Bevacizumab was adopted as first-line therapy for metastatic colorectal cancer (mCRC) based on significant survival improvements in initial clinical trials; however, survival benefit diminished in subsequent analyses. Consequently, there is uncertainty surrounding the cost-effectiveness of bevacizumab therapy achieved in practice. Objective. To assess real-world cost-effectiveness of first-line bevacizumab with irinotecan-based chemotherapy versus irinotecan-based chemotherapy alone for mCRC in British Columbia (BC), Saskatchewan, and Ontario, Canada. Methods. Using provincial cancer registries and linked administrative databases, we identified mCRC patients who initiated publicly funded irinotecan-based chemotherapy, with or without bevacizumab, in 2000 to 2015. We compared bevacizumab-treated patients to historical controls (treated before bevacizumab funding) and contemporaneous controls (receiving chemotherapy without bevacizumab), using inverse-probability-of-treatment weighting with propensity scores to balance baseline covariates. We calculated incremental cost-effectiveness ratios (ICER) using 5-year cost and survival adjusted for censoring, with bootstrapping to characterize uncertainty. We also conducted one-way sensitivity analysis for key drivers of cost-effectiveness. Results. The cohorts included 12,112 (Ontario), 1,161 (Saskatchewan), and 2,977 (BC) patients. Bevacizumab significantly increased treatment costs, with mean ICERs between $78,000 and $84,000/LYG (life-year gained) in the contemporaneous comparisons and $75,000 and $101,000/LYG in the historical comparisons. Reducing the cost of bevacizumab by 50% brought ICERs in all comparisons below $61,000/LYG. Limitations. Residual confounding in observational data may bias results, while the use of original list prices overestimates current bevacizumab cost. Conclusion. The addition of bevacizumab to irinotecan-based chemotherapy extended survival for mCRC patients but at significant cost. At original list prices bevacizumab can only be considered cost-effective with certainty at a willingness-to-pay threshold over $100,000/LYG, but price reductions or discounts have a significant impact on cost-effectiveness.
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Affiliation(s)
| | - Jaclyn Beca
- Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia and Toronto, Ontario, Canada
| | - David Tran
- Saskatchewan Cancer Agency, Saskatoon, Saskatchewan, Canada
| | - Wei Fang Dai
- Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia and Toronto, Ontario, Canada
| | | | - Wanrudee Isaranuwatchai
- Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia and Toronto, Ontario, Canada
| | | | - Riaz Alvi
- Saskatchewan Cancer Agency, Saskatoon, Saskatchewan, Canada
| | | | | | | | - Kelvin K W Chan
- Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia and Toronto, Ontario, Canada
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Kimura M, Usami E, Iwai M, Go M, Teramachi H, Yoshimura T. Comparison of cost-effectiveness of regorafenib and trifluridine/tipiracil combination tablet for treating advanced and recurrent colorectal cancer. Mol Clin Oncol 2016; 5:635-640. [PMID: 27900102 DOI: 10.3892/mco.2016.1020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 08/04/2016] [Indexed: 12/12/2022] Open
Abstract
Regorafenib and trifluridine/tipiracil combination tablet regimens are standard third-line or later treatments for advanced and recurrent colorectal cancer with no significant difference in efficacy. The present study aimed to compare the cost-effectiveness of using regorafenib vs. the trifluridine/tipiracil combination tablet. The expected cost was calculated based on data from patients with advanced and recurrent colorectal cancer who were treated with regorafenib or trifluridine/tipiracil combination tablet. The median survival time (MST) from the CORRECT and the RECOURSE study was used to evaluate the therapeutic efficacy of the regimens. The cost-effectiveness ratio was calculated from the expected cost and MST for the two regimens. The expected cost per patient for the regorafenib and the trifluridine/tipiracil combination tablet regimen was ¥705,330.3 and ¥371,198.7, respectively, and the cost-effectiveness ratio was ¥110,207.9/MST and ¥52,281.5/MST, respectively. In conclusion, the findings of the present study demonstrated that the trifluridine/tipiracil combination tablet regimen is more cost-effective compared with the regorafenib regimen.
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Affiliation(s)
- Michio Kimura
- Department of Pharmacy, Ogaki Municipal Hospital, Ogaki-shi, Gifu 503-8502, Japan
| | - Eiseki Usami
- Department of Pharmacy, Ogaki Municipal Hospital, Ogaki-shi, Gifu 503-8502, Japan
| | - Mina Iwai
- Department of Pharmacy, Ogaki Municipal Hospital, Ogaki-shi, Gifu 503-8502, Japan
| | - Makiko Go
- Department of Pharmacy, Ogaki Municipal Hospital, Ogaki-shi, Gifu 503-8502, Japan
| | - Hitomi Teramachi
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu-shi, Gifu 501-1196, Japan
| | - Tomoaki Yoshimura
- Department of Pharmacy, Ogaki Municipal Hospital, Ogaki-shi, Gifu 503-8502, Japan
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Franken MD, van Rooijen EM, Uyl-de Groot CA, van Oijen MGH, Koopman M. Cost–effectiveness in colorectal cancer: challenges on quality and comparability. COLORECTAL CANCER 2016. [DOI: 10.2217/crc.15.33] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Costs in colorectal cancer treatment are rising, especially since the availability of expensive targeted drugs. Comparisons between cost–effectiveness evaluations are restricted to differences in applied methodology, for example, differences in model assumptions and design, healthcare systems. Cost–effectiveness analyses should be performed and reported upon in a standardized manner within a disease area and in particular in oncology to facilitate better comparisons between treatments. Ideally, to evaluate the cost–effectiveness of a treatment in daily practice, models should be based on patient cohort studies or registries with appropriate prospective data collection from a societal perspective. Randomized clinical trials remain most suitable for comparison of treatment strategies and could estimate the budget impact of a novel treatment introduction.
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Affiliation(s)
- Mira D Franken
- Department of Medical Oncology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Elisabeth M van Rooijen
- Institute for Medical Technology Assessment/institute of Health Policy & Management, Erasmus University, PO Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Carin A Uyl-de Groot
- Institute for Medical Technology Assessment/institute of Health Policy & Management, Erasmus University, PO Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Martijn GH van Oijen
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
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Minion LE, Bai J, Monk BJ, Robin Keller L, Ramez EN, Forde GK, Chan JK, Tewari KS. A Markov model to evaluate cost-effectiveness of antiangiogenesis therapy using bevacizumab in advanced cervical cancer. Gynecol Oncol 2015; 137:490-6. [DOI: 10.1016/j.ygyno.2015.02.027] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/28/2015] [Indexed: 12/22/2022]
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