BACKGROUND: Since 1996, 6 new drugs have been introduced for the treatment of metastatic colorectal cancer. Although they are promising, these drugs frequently are given in the palliative and are much more expensive than older treatments. The objective of the current study was to measure the cost implications of treatment with sequential regimens that include chemotherapy and/or monoclonal antibodies. METHODS: A Markov model was used to evaluate a hypothetical cohort of 1000 patients with newly diagnosed, metastatic colorectal cancer. Patients supposedly received up to 3 lines of treatment before supportive care and subsequent death. Data were obtained from published, multicenter phase 2 and randomized phase 3 clinical trials. Sensitivity analyses were conducted on the efficacy, toxicity, and cost. RESULTS: Using drug costs alone, treatment that included new chemotherapeutic agents increased survival at an incremental cost-effectiveness ratio (ICER) of $100,000 per discounted life-year (DLY). The addition of monoclonal antibodies improved survival at an ICER of >$170,000 per DLY. The results were most sensitive to changes in the initial regimen. Even with significant improvements in clinical characteristics (efficacy and toxicity), treatment with the most effective regimens still had very high ICERs. CONCLUSIONS: Treatment of metastatic colorectal cancer with the most effective regimens came at very high incremental costs. The authors concluded that cost-effectiveness analyses should be a routine component of the drug-development process, so that physicians and patients are informed appropriately regarding the value of new innovations.
BACKGROUND: Since 1996, 6 new drugs have been introduced for the treatment of metastatic colorectal cancer. Although they are promising, these drugs frequently are given in the palliative and are much more expensive than older treatments. The objective of the current study was to measure the cost implications of treatment with sequential regimens that include chemotherapy and/or monoclonal antibodies. METHODS: A Markov model was used to evaluate a hypothetical cohort of 1000 patients with newly diagnosed, metastatic colorectal cancer. Patients supposedly received up to 3 lines of treatment before supportive care and subsequent death. Data were obtained from published, multicenter phase 2 and randomized phase 3 clinical trials. Sensitivity analyses were conducted on the efficacy, toxicity, and cost. RESULTS: Using drug costs alone, treatment that included new chemotherapeutic agents increased survival at an incremental cost-effectiveness ratio (ICER) of $100,000 per discounted life-year (DLY). The addition of monoclonal antibodies improved survival at an ICER of >$170,000 per DLY. The results were most sensitive to changes in the initial regimen. Even with significant improvements in clinical characteristics (efficacy and toxicity), treatment with the most effective regimens still had very high ICERs. CONCLUSIONS: Treatment of metastatic colorectal cancer with the most effective regimens came at very high incremental costs. The authors concluded that cost-effectiveness analyses should be a routine component of the drug-development process, so that physicians and patients are informed appropriately regarding the value of new innovations.
Authors: L B Saltz; J V Cox; C Blanke; L S Rosen; L Fehrenbacher; M J Moore; J A Maroun; S P Ackland; P K Locker; N Pirotta; G L Elfring; L L Miller Journal: N Engl J Med Date: 2000-09-28 Impact factor: 91.245
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Authors: Timothy Iveson; Kathleen A Boyd; Rachel S Kerr; Jose Robles-Zurita; Mark P Saunders; Andrew H Briggs; Jim Cassidy; Niels Henrik Hollander; Josep Tabernero; Andrew Haydon; Bengt Glimelius; Andrea Harkin; Karen Allan; John McQueen; Sarah Pearson; Ashita Waterston; Louise Medley; Charles Wilson; Richard Ellis; Sharadah Essapen; Amandeep S Dhadda; Mark Harrison; Stephen Falk; Sherif Raouf; Charlotte Rees; Rene K Olesen; David Propper; John Bridgewater; Ashraf Azzabi; David Farrugia; Andrew Webb; David Cunningham; Tamas Hickish; Andrew Weaver; Simon Gollins; Harpreet Wasan; James Paul Journal: Health Technol Assess Date: 2019-12 Impact factor: 4.014
Authors: Eric Jonasch; Lincy S Lal; Bradley J Atkinson; Stacey DaCosta Byfield; Lesley Ann Miller; Lance C Pagliaro; Chun Feng; Nizar M Tannir Journal: BJU Int Date: 2010-09-21 Impact factor: 5.588
Authors: Veena Shankaran; David Mummy; Lisel Koepl; Aasthaa Bansal; Dana K Mirick; Elaine Yu; Rob Morlock; Sarika Ogale; Scott D Ramsey Journal: Oncologist Date: 2014-08-01
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