title: Cost-effectiveness of cetuximab and panitumumab for chemotherapy-refractory metastatic colorectal cancer.
abstract: BACKGROUND
  Cetuximab and panitumumab are monoclonal antibodies targeting the epidermal growth factor receptor. Both drugs are active against RAS wild type metastatic colorectal cancer after chemotherapy failure, with similar efficacy and toxicity profiles. However, their cost and limited survival benefits may compromise incorporation in the Brazilian public healthcare system, the Unified Heath System (Sistema Único de Saúde) (SUS).
  
  
  METHODS
  A cost-effectiveness analysis was conducted using a Markov model from the Brazilian Public health perspective and a lifetime horizon in patients with RAS -wt mCRC. Transition probabilities and mortality rates were extracted from randomized studies. Treatment costs were obtained from price tables regulated by the Brazilian Health Ministry. The World Health Organization recommendation of three times GDP per capita was used to define the cost-effectiveness threshold.
  
  
  RESULTS
  The use of cetuximab or panitumumab for chemotherapy-refractory mCRC patients resulted in 0.22 additional life-years relative to BSC, with incremental cost-effectiveness ratios (ICERs) of $58,240 and $52,772 per LY, respectively. That exceeds the pre-specified threshold for cost-effectiveness. Acquisition of biological agents was the major driver of increased costs.
  
  
  CONCLUSIONS
  Our economic evaluation demonstrates that both cetuximab and panitumumab are not a cost-effective approach in RAS-wt mCRC patients. Discussion about drug price should be prioritized to enable incorporation of these monoclonal antibodies in the SUS.
authors.affiliation: Centre for Evidence in Oncology, Department of Internal Medicine, University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil.
authors.forename: Adriana Camargo
authors.initials: AC
authors.lastname: Carvalho
authors.affiliation: Centre for Evidence in Oncology, Department of Internal Medicine, University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil.
authors.forename: Frederico
authors.initials: F
authors.lastname: Leal
authors.affiliation: Centre for Evidence in Oncology, Department of Internal Medicine, University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil.
authors.forename: Andre Deeke
authors.identifier: http://orcid.org/0000-0002-3038-3933
authors.initials: AD
authors.lastname: Sasse
mesh_terms: D000911:Antibodies, Monoclonal / Q000191:economics* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D000068818:Cetuximab / Q000191:economics* / Q000627:therapeutic use; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000473:pathology; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D019008:Drug Resistance, Neoplasm; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000556:secondary; D000077544:Panitumumab; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D000077544:Panitumumab; D000068818:Cetuximab