Affiliation:
1. Shahid Beheshti University of Medical Sciences
Abstract
Abstract
Purpose
This study aimed to evaluate the cost-effectiveness of cetuximab in different genetic populations of metastatic colorectal carcinoma patients, including KRAS and RAS wild types and mutants, when added to FOLFIRI treatment regimens for evidence-based disease management in Iran.
Method
A Markov decision model was designed in TreeAge software with the three states of stable, progress, and death. Clinical outcomes were extracted from published clinical studies, and costs were extracted from the Iranian local data. The primary outcome was an incremental cost-effectiveness ratio (ICER) in the simulated population.
Results
The cost-utility model from the perspective of the health system indicated that the average direct medical costs of a patient that has not been genetically screened are $56985.27 and $20767.74 in FOLFIRI + cetuximab and FOLFIRI regimens, respectively. However, costs per patient in the KRAS wild-type population were $21845.52 in FOLFIRI and $78,321.22 in FOLFIRI + cetuximab. In RAS wild-type patients, FOLFIRI and FOLFIRI + cetuximab costs per patient were $23111.62 and $84976.39, respectively. Incremental QALYs for the above scenarios were 0.069, 0.193, and 0.285, respectively. Therefore, the ICER of add-on cetuximab in Iran compared to the treatment alternatives in the scenarios with and without KRAS screening was $520771.55/QALY, $292768.16/QALY, and $217460.51/QALY.
Conclusion
Although genetic screening in precision medicine reduces costs per outcome, according to the willingness-to-pay threshold of $4349.50 in the Iranian health system, add-on cetuximab to the FOLFIRI regimen is not a cost-effective strategy even with genetic screening and a 20% price reduction.
Publisher
Research Square Platform LLC
Reference31 articles.
1. Arnold M, Sierra MS, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global patterns and trends in colorectal cancer incidence and mortality. Gut. 2017 Apr 1;66(4):683–91.
2. Global cancer statistics, 2012;Torre LA;CA Cancer J Clin,2015
3. Park S, Jee SH. Epidemiology of Colorectal Cancer in Asia-Pacific Region. Surg Treat Color Cancer Asian Perspect Optim Stand [Internet]. 2018 May 2 [cited 2022 Apr 29];3–10. Available from: https://link.springer.com/chapter/10.1007/978-981-10-5143-2_1
4. Hull R, Francies FZ, Oyomno M, Dlamini Z. Colorectal Cancer Genetics, Incidence and Risk Factors: In Search for Targeted Therapies. Cancer Manag Res [Internet]. 2020 [cited 2022 Apr 29];12:9869. Available from: /pmc/articles/PMC7553623/
5. Zhou J, Zheng R, Zhang S, Zeng H, Wang S, Chen R, et al. Colorectal cancer burden and trends: Comparison between China and major burden countries in the world. Chinese J Cancer Res [Internet]. 2021 [cited 2022 Apr 29];33(1):1. Available from: /pmc/articles/PMC7941684/