title: [Cost-effectiveness analysis of aflibercept in combination with FOLFIRI in the treatment of patients with metastatic colorectal cancer].
abstract: OBJECTIVE
  To estimate the incremental cost per life-year gained (LYG) of aflibercept in combination with FOLFIRI as second-line treatment in metastatic colorectal cancer (mCRC) patients previously treated with oxaliplatin.
  
  
  METHODS
  Based on clinical trial VELOUR results, a three-state Markov model (stable disease, progression and death) with 2-week cycle duration was designed. Transition to health state «progression» implied the interruption of second-line treatment and administration of a third-line treatment (post-second line chemotherapy). Cost estimation included disease management cost (pharmaceutical, adverse event management, administration costs, etc.). Both cost and outcomes were discounted (3% annually). Sensitivity analyses (SA) were performed to test model robustness.
  
  
  RESULTS
  Administration of aflibercept + FOLFIRI as second-line treatment provided 1.78 LYG (21 life-months gained). With FOLFIRI 1.43 LYG (17 months) were obtained. The cost of the clinical management of aflibercept + FOLFIRI implied an additional investment of Euros 13,564 compared with FOLFIRI for a lifetime horizon, being total costs for aflibercept + FOLFIRI of Euros 38,346, compared to Euros 24,782 with FOLFIRI. In the cost-effectiveness analysis Euros 38,931/LYG was obtained with aflibercept in combination with FOLFIRI versus FOLFIRI.
  
  
  CONCLUSIONS
  Aflibercept in combination with FOLFIRI increased overall survival versus FOLFIRI, so it is an effective strategy in the treatment of patients with mCRC. Aflibercept in combination with FOLFIRI is an efficient strategy for second-line mCRC treatment from the National Health System perspective.
authors.affiliation: Servicio de Farmacia. Corporació Sanitária Parc Taulí. Barcelona.. cpericay@gmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Pericay
authors.affiliation: Servicio de Oncología. Instituto Catalán de Oncología. Barcelona.. mcfrias@tauli.cat.
authors.forename: C
authors.initials: C
authors.lastname: Frías
authors.affiliation: Servicio de Farmacia. Complejo Hospitalario Universitario de Santiago de Compostela.. aabade@seom.org.
authors.forename: A
authors.initials: A
authors.lastname: Abad
authors.affiliation: Pharmacoeconomics & Outcomes Research Iberia. Madrid.. Maria.Jesus.Lamas.Diaz@sergas.es.
authors.forename: M J
authors.initials: MJ
authors.lastname: Lamas
authors.affiliation: Servicio de Oncología. Corporació Sanitária Parc Taulí. Barcelona.. mechave@porib.com.
authors.forename: M
authors.initials: M
authors.lastname: Echave
authors.affiliation: Pharmacoeconomics & Outcomes Research Iberia. Madrid.. ioyaguez@porib.com.
authors.forename: I
authors.initials: I
authors.lastname: Oyagüez
authors.affiliation: Departamento de Health Economics. Sanofi.. Marta.Rubio@sanofi.com.
authors.forename: M
authors.initials: M
authors.lastname: Rubio
authors.affiliation: Departamento de Health Economics. Sanofi.. Emmanuel.GimenezGarcia@sanofi.com.
authors.forename: E
authors.initials: E
authors.lastname: Giménez
authors.affiliation: Sanofi. Sarah.Naoshy@sanofi.com.
authors.forename: S
authors.initials: S
authors.lastname: Naoshy
authors.affiliation: Sanofi. Florence.Joulain@sanofi.com.
authors.forename: F
authors.initials: F
authors.lastname: Joulain
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use*; D002166:Camptothecin / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000473:pathology; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D005472:Fluorouracil / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D002955:Leucovorin / Q000191:economics / Q000627:therapeutic use; D008390:Markov Chains; D009362:Neoplasm Metastasis; D040262:Receptors, Vascular Endothelial Growth Factor / Q000191:economics* / Q000627:therapeutic use*; D011993:Recombinant Fusion Proteins / Q000191:economics* / Q000627:therapeutic use*
chemical_list: D011993:Recombinant Fusion Proteins; C533178:aflibercept; D040262:Receptors, Vascular Endothelial Growth Factor; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin