M D Franken1, E M van Rooijen2, A M May3, H Koffijberg4, H van Tinteren5, L Mol6, A J Ten Tije7, G J Creemers8, A M T van der Velden9, B C Tanis10, C A Uyl-de Groot2, C J A Punt11, M Koopman1, M G H van Oijen12. 1. University Medical Center Utrecht, Department of Medical Oncology, P.O. Box 85500, 3508 GA Utrecht, The Netherlands. 2. Institute for Medical Technology Assessment/Institute of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands. 3. Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands. 4. Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands; Department of Health Technology & Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands. 5. The Netherlands Cancer Institute, Department of Biostatistics, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands. 6. Netherlands Comprehensive Cancer Organization, P.O. Box 1281, 6501 BG Nijmegen, The Netherlands. 7. Amphia Hospital, Department of Medical Oncology, P.O. Box 90158, 4800 RK Breda, The Netherlands. 8. Catharina Hospital, Department of Medical Oncology, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands. 9. Tergooi Hospital, Department of Medical Oncology, P.O. Box 10016, 1201 DA Hilversum, The Netherlands. 10. Groene Hart Hospital, Department of Medical Oncology, P.O. Box 1098, 2800 BB Gouda, The Netherlands. 11. Academic Medical Center, Department of Medical Oncology, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands. 12. Academic Medical Center, Department of Medical Oncology, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands. Electronic address: m.g.vanoijen@amc.uva.nl.
Abstract
AIM: Capecitabine and bevacizumab (CAP-B) maintenance therapy has shown to be more effective compared with observation in metastatic colorectal cancer patients achieving stable disease or better after six cycles of first-line capecitabine, oxaliplatin, bevacizumab treatment in terms of progression-free survival. We evaluated the cost-effectiveness of CAP-B maintenance treatment. METHODS: Decision analysis with Markov modelling to evaluate the cost-effectiveness of CAP-B maintenance compared with observation was performed based on CAIRO3 study results (n = 558). An additional analysis was performed in patients with complete or partial response. The primary outcomes were the incremental cost-effectiveness ratio (ICER) defined as the additional cost per life year (LY) and quality-adjusted life years (QALY) gained, calculated from EQ-5D questionnaires and literature and LYs gained. Univariable sensitivity analysis was performed to assess the influence of input parameters on the ICER, and a probabilistic sensitivity analysis represents uncertainty in model parameters. RESULTS:CAP-B maintenance compared with observation resulted in 0.21 QALYs (0.18LYs) gained at a mean cost increase of €36,845, yielding an ICER of €175,452 per QALY (€204,694 per LY). Varying the difference in health-related quality of life between CAP-B maintenance and observation influenced the ICER most. For patients achieving complete or partial response on capecitabine, oxaliplatin, bevacizumab induction treatment, an ICER of €149,300 per QALY was calculated. CONCLUSION:CAP-B maintenance results in improved health outcomes measured in QALYs and LYs compared with observation, but also in a relevant increase in costs. Despite the fact that there is no consensus on cost-effectiveness thresholds in cancer treatment, CAP-B maintenance may not be considered cost-effective.
RCT Entities:
AIM: Capecitabine and bevacizumab (CAP-B) maintenance therapy has shown to be more effective compared with observation in metastatic colorectal cancerpatients achieving stable disease or better after six cycles of first-line capecitabine, oxaliplatin, bevacizumab treatment in terms of progression-free survival. We evaluated the cost-effectiveness of CAP-B maintenance treatment. METHODS: Decision analysis with Markov modelling to evaluate the cost-effectiveness of CAP-B maintenance compared with observation was performed based on CAIRO3 study results (n = 558). An additional analysis was performed in patients with complete or partial response. The primary outcomes were the incremental cost-effectiveness ratio (ICER) defined as the additional cost per life year (LY) and quality-adjusted life years (QALY) gained, calculated from EQ-5D questionnaires and literature and LYs gained. Univariable sensitivity analysis was performed to assess the influence of input parameters on the ICER, and a probabilistic sensitivity analysis represents uncertainty in model parameters. RESULTS: CAP-B maintenance compared with observation resulted in 0.21 QALYs (0.18LYs) gained at a mean cost increase of €36,845, yielding an ICER of €175,452 per QALY (€204,694 per LY). Varying the difference in health-related quality of life between CAP-B maintenance and observation influenced the ICER most. For patients achieving complete or partial response on capecitabine, oxaliplatin, bevacizumab induction treatment, an ICER of €149,300 per QALY was calculated. CONCLUSION: CAP-B maintenance results in improved health outcomes measured in QALYs and LYs compared with observation, but also in a relevant increase in costs. Despite the fact that there is no consensus on cost-effectiveness thresholds in cancer treatment, CAP-B maintenance may not be considered cost-effective.
Authors: Scott K Sherman; Joel J Lange; Fadi S Dahdaleh; Rahul Rajeev; T Clark Gamblin; Blase N Polite; Kiran K Turaga Journal: JAMA Oncol Date: 2019-02-01 Impact factor: 31.777
Authors: Koen Degeling; Hendrik Koffijberg; Mira D Franken; Miriam Koopman; Maarten J IJzerman Journal: Med Decis Making Date: 2019-01 Impact factor: 2.583