title: Cost-effectiveness of RAS screening before monoclonal antibodies therapy in metastatic colorectal cancer based on FIRE3 Study.
abstract: The surprising results published by FIRE-3 revealed that the overall survival (OS) of RAS wild-type metastatic colorectal cancer (mCRC) patients treated with Cetuximab(Cmab) and FOLFIRI combination was prolonged to 33.1 months. The substantial increase in testing and treatment costs, however, impose a considerable health burden on patients and society. Hence the study was aimed to assess the cost-effectiveness of RAS screening before monoclonal antibodies (mAbs) therapy based on FIRE-3 study. Four groups were analyzed: group 1, patients with KRAS testing treated with Cmab and FOLFIRI; group 2, patients with RAS testing treated with Cmab and FOLFIRI; group 3, patients with KRAS testing treated with bevacizumab(Bmab) and FOLFIRI; group 4, patients with RAS testing treated with Bmab and FOLFIRI. A Markov model comprising 3 health states (progression-free survival, progressive disease and death) was built. The costs were calculated from a Chinese payer perspective, and survival was reported in quality-adjusted life-months (QALMs). Average total lifetime costs ranged from $104,682.44 (RAS-Bmab) to $136,867.44 (RAS-Cmab), while the survival gained varied from 16.88 QALMs in RAS-Bmab to 21.85 QALMs in RAS-Cmab. The cost per QALM was $6,263.86 for RAS-Cmab, $6,145.84 for KRAS-Bmab, $6,201.57 for RAS-Bmab and $6,960.70 for KRAS-Cmab respectively. The KRAS-Cmab strategy was dominated by the other 3 groups. The first-treatment cost of RAS-Cmab was the most influential one to the model. In all, the RAS screening prior to Cmab treatment in mCRC seems to be a cost-effective strategy in the time of monoclonal antibodies (mAbs) therapy with the most gained QALMs.
authors.affiliation: a Department of Medical Oncology ; Cancer Center; State Key Laboratory of Biotherapy; West China Hospital; Sichuan University ; Chengdu , China.|b West China Biostatistics and Cost-Benefit Analysis Center; Sichuan University ; Chengdu , China.|e These authors contributed equally to this work.
authors.forename: Feng
authors.initials: F
authors.lastname: Wen
authors.affiliation: a Department of Medical Oncology ; Cancer Center; State Key Laboratory of Biotherapy; West China Hospital; Sichuan University ; Chengdu , China.|b West China Biostatistics and Cost-Benefit Analysis Center; Sichuan University ; Chengdu , China.|e These authors contributed equally to this work.
authors.forename: Yu
authors.initials: Y
authors.lastname: Yang
authors.affiliation: a Department of Medical Oncology ; Cancer Center; State Key Laboratory of Biotherapy; West China Hospital; Sichuan University ; Chengdu , China.|b West China Biostatistics and Cost-Benefit Analysis Center; Sichuan University ; Chengdu , China.
authors.forename: Pengfei
authors.initials: P
authors.lastname: Zhang
authors.affiliation: a Department of Medical Oncology ; Cancer Center; State Key Laboratory of Biotherapy; West China Hospital; Sichuan University ; Chengdu , China.|b West China Biostatistics and Cost-Benefit Analysis Center; Sichuan University ; Chengdu , China.
authors.forename: Jian
authors.initials: J
authors.lastname: Zhang
authors.affiliation: a Department of Medical Oncology ; Cancer Center; State Key Laboratory of Biotherapy; West China Hospital; Sichuan University ; Chengdu , China.|b West China Biostatistics and Cost-Benefit Analysis Center; Sichuan University ; Chengdu , China.
authors.forename: Jing
authors.initials: J
authors.lastname: Zhou
authors.affiliation: a Department of Medical Oncology ; Cancer Center; State Key Laboratory of Biotherapy; West China Hospital; Sichuan University ; Chengdu , China.|b West China Biostatistics and Cost-Benefit Analysis Center; Sichuan University ; Chengdu , China.
authors.forename: Ruilei
authors.initials: R
authors.lastname: Tang
authors.affiliation: a Department of Medical Oncology ; Cancer Center; State Key Laboratory of Biotherapy; West China Hospital; Sichuan University ; Chengdu , China.|b West China Biostatistics and Cost-Benefit Analysis Center; Sichuan University ; Chengdu , China.
authors.forename: Hongdou
authors.initials: H
authors.lastname: Chen
authors.affiliation: b West China Biostatistics and Cost-Benefit Analysis Center; Sichuan University ; Chengdu , China.|c Department of Clinical Pharmacy ; West China Hospital; Sichuan University ; Chengdu , China.
authors.forename: Hanrui
authors.initials: H
authors.lastname: Zheng
authors.affiliation: b West China Biostatistics and Cost-Benefit Analysis Center; Sichuan University ; Chengdu , China.|d Division of Nephrology of Department of Internal Medicine ; West China Hospital; Sichuan University ; Chengdu , China.
authors.forename: Ping
authors.initials: P
authors.lastname: Fu
authors.affiliation: a Department of Medical Oncology ; Cancer Center; State Key Laboratory of Biotherapy; West China Hospital; Sichuan University ; Chengdu , China.|b West China Biostatistics and Cost-Benefit Analysis Center; Sichuan University ; Chengdu , China.
authors.forename: Qiu
authors.initials: Q
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000008:administration & dosage; D000068818:Cetuximab / Q000008:administration & dosage; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000235:genetics / Q000473:pathology; D003362:Cost-Benefit Analysis; D004252:DNA Mutational Analysis; D018572:Disease-Free Survival; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis; D016283:Proto-Oncogene Proteins p21(ras) / Q000235:genetics*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: C117307:KRAS protein, human; D000068258:Bevacizumab; D016283:Proto-Oncogene Proteins p21(ras); D000068818:Cetuximab
keywords: RAS screening; cost-effectiveness; metastatic colorectal cancer; monoclonal antibodies chemotherapy