title: Metastatic Colorectal Cancer: A Systematic Review of the Value of Current Therapies.
abstract: To evaluate, from a US payer perspective, the cost-effectiveness of treatment strategies for metastatic colorectal cancer (mCRC), we performed a systematic review of published cost-effectiveness analyses. We identified 14 papers that fulfilled our search criteria and revealed varying levels of value among current treatment strategies. Older agents such as 5-fluorouracil, irinotecan, and oxaliplatin provide high-value treatments. More modern agents targeting the EGFR or VEGF pathways, such as bevacizumab, cetuximab, and panitumumab, do not appear to be cost-effective treatments at their current costs. The analytical methods used within the papers varied widely, and this variation likely plays a significant role in the heterogeneity in incremental cost-effectiveness ratios. The cost-effectiveness of current treatment strategies for mCRC is highly variable. Drugs recently approved by the US Food and Drug Administration for mCRC are not cost-effective, and this is primarily driven by high drug costs.
authors.affiliation: Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA. Electronic address: dgolds8@emory.edu.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Goldstein
authors.affiliation: Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA.
authors.forename: Simon B
authors.initials: SB
authors.lastname: Zeichner
authors.affiliation: Department of Medicine, Emory University, Atlanta, GA.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Bartnik
authors.affiliation: Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA.
authors.forename: Eli
authors.initials: E
authors.lastname: Neustadter
authors.affiliation: Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Flowers
mesh_terms: D020533:Angiogenesis Inhibitors / Q000191:economics / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000008:administration & dosage / Q000191:economics; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D000068818:Cetuximab / Q000008:administration & dosage / Q000191:economics; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005472:Fluorouracil / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D000077146:Irinotecan; D002955:Leucovorin / Q000191:economics / Q000627:therapeutic use; D009362:Neoplasm Metastasis / Q000188:drug therapy*; D009944:Organoplatinum Compounds / Q000008:administration & dosage / Q000191:economics; D000077150:Oxaliplatin; D000077544:Panitumumab; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome; D014481:United States
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D000068258:Bevacizumab; D000077544:Panitumumab; D000077146:Irinotecan; D000068818:Cetuximab; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin
keywords: Chemotherapy; Colorectal cancer; Cost-effectiveness; Incremental cost effectiveness ratio; Value