Cost-Effectiveness of Cetuximab for Advanced Esophageal Squamous Cell Carcinoma.
BACKGROUND
Costly biologicals in palliative oncology are emerging at a rapid pace. For example, in patients with advanced esophageal squamous cell carcinoma addition of cetuximab to a palliative chemotherapy regimen appears to improve survival. However, it simultaneously results in higher costs. We aimed to determine the incremental cost-effectiveness ratio of adding cetuximab to first-line chemotherapeutic treatment of patients with advanced esophageal squamous cell carcinoma, based on data from a randomized controlled phase II trial.


METHODS
A cost effectiveness analysis model was applied based on individual patient data. It included only direct medical costs from the health-care perspective. Quality-adjusted life-years and incremental cost-effectiveness ratios were calculated. Sensitivity analysis was performed by a Monte Carlo analysis.


RESULTS
Adding cetuximab to a cisplatin-5-fluorouracil first-line regimen for advanced esophageal squamous cell carcinoma resulted in an the incremental cost-effectiveness ratio of €252,203 per quality-adjusted life-year. Sensitivity analysis shows that there is a chance of less than 0.001 that the incremental cost-effectiveness ratio will be less than a maximum willingness to pay threshold of €40,000 per quality-adjusted life-year, which is representative for the threshold used in The Netherlands and other developed countries.


CONCLUSIONS
Addition of cetuximab to a cisplatin-5-fluorouracil first-line regimen for advanced esophageal squamous cell carcinoma is not cost-effective when appraised according to currently accepted criteria. Cost-effectiveness analyses using outcome data from early clinical trials (i.c. a phase II trial) enable pharmaceutical companies and policy makers to gain early insight into whether a new drug meets the current eligibility standards for reimbursement and thereby potential admittance for use in regular clinical practice.
Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.
Vincent T
http://orcid.org/0000-0002-8279-1816
VT
Janmaat
Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.
Marco J
MJ
Bruno
Department of Public Health, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.
Suzanne
S
Polinder
Third Department of Internal Medicine (Hematology/Medical Oncology), Technical University of Munich, Munich, Germany.
Sylvie
S
Lorenzen
University Cancer Center Leipzig (UCCL),Leipzig University,Leipzig, Germany.
Florian
F
Lordick
Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.
Maikel P
MP
Peppelenbosch
Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.
Manon C W
MC
Spaander
D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000191:economics*; D000068818:Cetuximab / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000191:economics*; D000077277:Esophageal Squamous Cell Carcinoma; D004947:Esophagus / Q000187:drug effects; D006801:Humans; D009010:Monte Carlo Method; D019057:Quality-Adjusted Life Years
D000970:Antineoplastic Agents; D000068818:Cetuximab