Wânia Cristina da Silva1, Brian Godman2,3,4,5, Francisco de Assis Acúrcio6,7, Mariângela Leal Cherchiglia6,7, Antony Martin4, Konrad Maruszczyk8, Jans Bastos Izidoro9, Marcos André Portella10, Agner Pereira Lana7, Orozimbo Henriques Campos Neto11, Eli Iola Gurgel Andrade6,7. 1. Postgraduate Program in Medicines and Pharmaceutical Services, School of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil. wania_logistica@hotmail.com. 2. Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK. 3. Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden. 4. Health Economics Centre, University of Liverpool Management School, Liverpool, UK. 5. Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa. 6. Postgraduate Program in Medicines and Pharmaceutical Services, School of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil. 7. Postgraduate Program in Public Health, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil. 8. Health Economics Services, Warsaw, Poland. 9. Divisão de Medicamentos Essenciais, Departamento de Assistência Farmacêutica, Secretaria de Estado de Saúde de Minas Gerais, Belo Horizonte, Brazil. 10. Mario Penna Institute of Oncology-Minas Gerais, Belo Horizonte, Brazil. 11. Associate Professor of Undergraduate Pharmacy, Faculdade Ciências da Vida (FCV), Sete Lagoas, Brazil.
Abstract
INTRODUCTION: Biological medicines have increased the cost of cancer treatments, which also raises concerns about sustainability. In Brazil, three monoclonal antibodies (mAbs)-bevacizumab, cetuximab, and panitumumab-are indicated for the treatment of metastatic colorectal cancer (mCRC) but not currently funded by the Unified Health System (SUS). However, successful litigation has led to funding in some cases. OBJECTIVE: Our objective was to evaluate the budgetary impact of including the mAbs bevacizumab, cetuximab, and panitumumab in standard chemotherapy for the treatment of mCRC within the SUS of Minas Gerais (MG), Brazil. METHOD: A budget impact analysis of incorporating mAbs as first-line treatment of mCRC in MG was explored. The perspective taken was that of the Brazilian SUS, and a 5-year time horizon was applied. Data were collected from lawsuits undertaken between January 2009 and December 2016, and the model was populated with data from national databases and published sources. Costs are expressed in $US. RESULTS: In total, 351 lawsuits resulted in funding for first-line treatment with mAbs for mCRC. The three alternative scenarios analyzed resulted in cost increases of 348-395% compared with the reference scenario. The use of panitumumab had a budgetary impact of $US103,360,980 compared with the reference scenario over a 5-year time horizon, and bevacizumab and cetuximab had budgetary impacts of $US111,334,890 and 113,772,870, respectively. The use of the anti-epidermal growth factor receptor (EGFR) mAbs (cetuximab and panitumumab) is restricted to the approximately 41% of patients with KRAS mutations, so the best cost alternative for incorporation would be the combination of panitumumab and bevacizumab, with a cost of approximately $US106 million. CONCLUSION: These results highlight the appreciable costs for incorporating bevacizumab, cetuximab, and panitumumab into the SUS. Appreciable discounts are likely to be necessary before incorporation of these mAbs is approved.
INTRODUCTION: Biological medicines have increased the cost of cancer treatments, which also raises concerns about sustainability. In Brazil, three monoclonal antibodies (mAbs)-bevacizumab, cetuximab, and panitumumab-are indicated for the treatment of metastatic colorectal cancer (mCRC) but not currently funded by the Unified Health System (SUS). However, successful litigation has led to funding in some cases. OBJECTIVE: Our objective was to evaluate the budgetary impact of including the mAbs bevacizumab, cetuximab, and panitumumab in standard chemotherapy for the treatment of mCRC within the SUS of Minas Gerais (MG), Brazil. METHOD: A budget impact analysis of incorporating mAbs as first-line treatment of mCRC in MG was explored. The perspective taken was that of the Brazilian SUS, and a 5-year time horizon was applied. Data were collected from lawsuits undertaken between January 2009 and December 2016, and the model was populated with data from national databases and published sources. Costs are expressed in $US. RESULTS: In total, 351 lawsuits resulted in funding for first-line treatment with mAbs for mCRC. The three alternative scenarios analyzed resulted in cost increases of 348-395% compared with the reference scenario. The use of panitumumab had a budgetary impact of $US103,360,980 compared with the reference scenario over a 5-year time horizon, and bevacizumab and cetuximab had budgetary impacts of $US111,334,890 and 113,772,870, respectively. The use of the anti-epidermal growth factor receptor (EGFR) mAbs (cetuximab and panitumumab) is restricted to the approximately 41% of patients with KRAS mutations, so the best cost alternative for incorporation would be the combination of panitumumab and bevacizumab, with a cost of approximately $US106 million. CONCLUSION: These results highlight the appreciable costs for incorporating bevacizumab, cetuximab, and panitumumab into the SUS. Appreciable discounts are likely to be necessary before incorporation of these mAbs is approved.
Authors: Andrea C B Silva; Maria Fernanda B Vicentini; Elizabeth Z Mendoza; Fernanda K Fujiki; Leonardo G da Fonseca; Maria Ignez F M Braghiroli; Paulo M Hoff Journal: Curr Probl Cancer Date: 2019-02-20 Impact factor: 3.187
Authors: Dyego L B Souza; Javier Jerez-Roig; Francisco J Cabral; José Roberto F de Lima; Michael K Rutalira; Juan Adrizio G Costa Journal: Dis Colon Rectum Date: 2014-09 Impact factor: 4.585
Authors: Zhobin Moghadamyeghaneh; Reza Fazl Alizadeh; Michael Phelan; Joseph C Carmichael; Steven Mills; Alessio Pigazzi; Jason A Zell; Michael J Stamos Journal: Surg Endosc Date: 2015-11-05 Impact factor: 4.584
Authors: Brian Godman; Anna Bucsics; Patricia Vella Bonanno; Wija Oortwijn; Celia C Rothe; Alessandra Ferrario; Simone Bosselli; Andrew Hill; Antony P Martin; Steven Simoens; Amanj Kurdi; Mohamed Gad; Jolanta Gulbinovič; Angela Timoney; Tomasz Bochenek; Ahmed Salem; Iris Hoxha; Robert Sauermann; Amos Massele; Augusto Alfonso Guerra; Guenka Petrova; Zornitsa Mitkova; Gnosia Achniotou; Ott Laius; Catherine Sermet; Gisbert Selke; Vasileios Kourafalos; John Yfantopoulos; Einar Magnusson; Roberta Joppi; Margaret Oluka; Hye-Young Kwon; Arianit Jakupi; Francis Kalemeera; Joseph O Fadare; Oyvind Melien; Maciej Pomorski; Magdalene Wladysiuk; Vanda Marković-Peković; Ileana Mardare; Dmitry Meshkov; Tanja Novakovic; Jurij Fürst; Dominik Tomek; Corrine Zara; Eduardo Diogene; Johanna C Meyer; Rickard Malmström; Björn Wettermark; Zinhle Matsebula; Stephen Campbell; Alan Haycox Journal: Front Public Health Date: 2018-12-05