title: Cost-effectiveness analysis in the Spanish setting of the PEAK trial of panitumumab plus mFOLFOX6 compared with bevacizumab plus mFOLFOX6 for first-line treatment of patients with wild-type RAS metastatic colorectal cancer.
abstract: OBJECTIVE
  To assess the cost-effectiveness of panitumumab in combination with mFOLFOX6 (oxaliplatin, 5-fluorouracil, and leucovorin) vs bevacizumab in combination with mFOLFOX6 as first-line treatment of patients with wild-type RAS metastatic colorectal cancer (mCRC) in Spain.
  
  
  METHODS
  A semi-Markov model was developed including the following health states: Progression free; Progressive disease: Treat with best supportive care; Progressive disease: Treat with subsequent active therapy; Attempted resection of metastases; Disease free after metastases resection; Progressive disease: after resection and relapse; and Death. Parametric survival analyses of patient-level progression free survival and overall survival data from the PEAK Phase II clinical trial were used to estimate health state transitions. Additional data from the PEAK trial were considered for the dose and duration of therapy, the use of subsequent therapy, the occurrence of adverse events, and the incidence and probability of time to metastasis resection. Utility weightings were calculated from patient-level data from panitumumab trials evaluating first-, second-, and third-line treatments. The study was performed from the Spanish National Health System (NHS) perspective including only direct costs. A life-time horizon was applied. Probabilistic sensitivity analyses and scenario sensitivity analyses were performed to assess the robustness of the model.
  
  
  RESULTS
  Based on the PEAK trial, which demonstrated greater efficacy of panitumumab vs bevacizumab, both in combination with mFOLFOX6 first-line in wild-type RAS mCRC patients, the estimated incremental cost per life-year gained was €16,567 and the estimated incremental cost per quality-adjusted life year gained was €22,794. The sensitivity analyses showed the model was robust to alternative parameters and assumptions.
  
  
  CONCLUSIONS
  The analysis was based on a simulation model and, therefore, the results should be interpreted cautiously.
  
  
  CONCLUSIONS
  Based on the PEAK Phase II clinical trial and taking into account Spanish costs, the results of the analysis showed that first-line treatment of mCRC with panitumumab + mFOLFOX6 could be considered a cost-effective option compared with bevacizumab + mFOLFOX6 for the Spanish NHS.
authors.affiliation: a Hospital Universitario Marqués de Valdecilla , Santander , Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Rivera
authors.affiliation: b Hospital Universitario Virgen del Rocío , Sevilla , Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Valladares
authors.affiliation: c Unidad de Farmacoeconomía e Investigación de Resultados en Salud, AMGEN , S . A. , Barcelona , Spain.
authors.forename: Salvador
authors.initials: S
authors.lastname: Gea
authors.affiliation: d Oblikue Consulting S.L. , Barcelona , Spain.
authors.forename: Noemí
authors.initials: N
authors.lastname: López-Martínez
mesh_terms: D020533:Angiogenesis Inhibitors / Q000191:economics / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000191:economics / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000191:economics / Q000627:therapeutic use*; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000235:genetics; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D005472:Fluorouracil / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D002955:Leucovorin / Q000191:economics / Q000627:therapeutic use; D008390:Markov Chains; D009364:Neoplasm Recurrence, Local; D009944:Organoplatinum Compounds / Q000191:economics / Q000627:therapeutic use; D000077544:Panitumumab; D019057:Quality-Adjusted Life Years; D013030:Spain; D018631:ras Proteins
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D009944:Organoplatinum Compounds; D000068258:Bevacizumab; D000077544:Panitumumab; D018631:ras Proteins; D002955:Leucovorin; D005472:Fluorouracil
keywords: Panitumumab; cost-effectiveness analysis; metastatic colorectal cancer; wild-type RAS