title: Cost-effectiveness of first-line treatments for patients with KRAS wild-type metastatic colorectal cancer.
abstract: BACKGROUND
  Combinations of chemotherapy regimens and monoclonal antibodies have been demonstrated to improve clinical outcomes in patients with metastatic colorectal cancer (mcrc). Although these combination treatment strategies are safe and effective in first-line treatment for mcrc, little is known about their economic consequences and resource allocation implications. In the present study, we evaluated the cost-effectiveness of bevacizumab plus folfiri, cetuximab plus folfiri, and panitumumab plus folfiri for patients with KRAS wild-type mcrc.
  
  
  METHODS
  A Markov model simulated the lifetime patient outcomes and costs of each first-line treatment strategy and subsequent lines of treatment from the perspective of the health care payer in Ontario. The model was parameterized using data from the Ontario Cancer Registry, Ontario health administrative databases, and published randomized control trials. Patient outcomes were measured in quality-adjusted life years (qalys), and costs were measured in monetary terms. Costs and outcomes were both discounted at 5% and expressed in 2012 Canadian dollars.
  
  
  RESULTS
  For mcrc patients with KRAS wild-type disease, the treatment strategy of bevacizumab plus folfiri was found to dominate the other two first-line treatment strategies. Sensitivity analyses revealed that the incremental cost-effectiveness ratio values were sensitive to the effectiveness of treatment, the costs of bevacizumab and cetuximab, and health utility values.
  
  
  CONCLUSIONS
  Evidence from Ontario showed that bevacizumab plus folfiri is the cost-effective first-line treatment strategy for patients with KRAS wild-type mcrc. The panitumumab plus folfiri and cetuximab plus folfiri options were both dominated, but the cetuximab plus folfiri strategy must be further investigated given that, in the sensitivity analyses, the cost-effectiveness of that strategy was found to be superior to that of bevacizumab plus folfiri under certain ranges of parameter values.
authors.affiliation: Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON.
authors.forename: E M
authors.initials: EM
authors.lastname: Ewara
authors.affiliation: Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON. ; Richard Ivey School of Business, Western University, London, ON.
authors.forename: G S
authors.initials: GS
authors.lastname: Zaric
authors.affiliation: Division of Medical Oncology, Department of Oncology, Western University, London, ON.
authors.forename: S
authors.initials: S
authors.lastname: Welch
authors.affiliation: Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON.
authors.forename: S
authors.initials: S
authors.lastname: Sarma
keywords: Cost-effectiveness; Ontario; bevacizumab; cetuximab; folfiri; metastatic colorectal cancer; panitumumab; wild-type KRAS
references.citation: Ann Oncol. 2012 Jul;23(7):1693-9
references.pmid: 22219013
references.citation: J Clin Oncol. 2009 Mar 1;27(7):1130-6
references.pmid: 19124802
references.citation: Int J Colorectal Dis. 2011 Feb;26(2):173-81
references.pmid: 21190026
references.citation: Pharmacoeconomics. 2013 Aug;31(8):663-75
references.pmid: 23673905
references.citation: J Clin Oncol. 2004 Jan 15;22(2):229-37
references.pmid: 14657227
references.citation: J Clin Oncol. 2007 Oct 20;25(30):4779-86
references.pmid: 17947725
references.citation: J Clin Oncol. 2005 Aug 1;23(22):4866-75
references.pmid: 15939922
references.citation: J Clin Oncol. 2011 May 20;29(15):2011-9
references.pmid: 21502544
references.citation: N Engl J Med. 2009 Apr 2;360(14):1408-17
references.pmid: 19339720
references.citation: Health Technol Assess. 2010 Oct;14(Suppl. 2):47-53
references.pmid: 21047491
references.citation: Clin Ther. 2011 Apr;33(4):482-97
references.pmid: 21635994
references.citation: J Clin Oncol. 2010 Nov 1;28(31):4697-705
references.pmid: 20921465
references.citation: Eur J Cancer. 2006 Sep;42(14):2212-21
references.pmid: 16904315
references.citation: J Clin Oncol. 2008 Apr 20;26(12):2013-9
references.pmid: 18421054
references.citation: Curr Oncol. 2010 Oct;17(5):12-6
references.pmid: 20975873
references.citation: J Clin Oncol. 2006 Jul 20;24(21):3347-53
references.pmid: 16849748
references.citation: Ann Oncol. 2010 Jun;21(6):1152-1162
references.pmid: 19942597
references.citation: Cancer. 2000 Mar 15;88(6):1294-303
references.pmid: 10717609
references.citation: J Clin Oncol. 2007 Oct 10;25(29):4575-80
references.pmid: 17925551
references.citation: Br J Cancer. 2011 Nov 8;105(10):1495-502
references.pmid: 21989186
references.citation: CA Cancer J Clin. 2011 Mar-Apr;61(2):69-90
references.pmid: 21296855
references.citation: Oncology. 2009;77(2):113-9
references.pmid: 19628950
references.citation: J Clin Oncol. 2007 May 1;25(13):1658-64
references.pmid: 17470858
references.citation: Pharmacoeconomics. 2007;25(1):3-6
references.pmid: 17192114
references.citation: J Surg Oncol. 2011 Nov 1;104(6):661-6
references.pmid: 21671463
references.citation: J Clin Oncol. 2008 Nov 20;26(33):5326-34
references.pmid: 18854571
references.citation: Ann Oncol. 2009 Nov;20(11):1842-7
references.pmid: 19406901