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.
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.


LIMITATIONS
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.
['Rivera|Fernando|F|', 'Valladares|Manuel|M|', 'Gea|Salvador|S|', 'López-Martínez|Noemí|N|']
D020533:Angiogenesis Inhibitors D000911:Antibodies, Monoclonal D000971:Antineoplastic Combined Chemotherapy Protocols D000068258:Bevacizumab D015179:Colorectal Neoplasms D003362:Cost-Benefit Analysis D018572:Disease-Free Survival D005472:Fluorouracil D006801:Humans D002955:Leucovorin D008390:Markov Chains D009364:Neoplasm Recurrence, Local D009944:Organoplatinum Compounds D000077544:Panitumumab D019057:Quality-Adjusted Life Years D013030:Spain D018631:ras Proteins
cost-effectiveness analysis Panitumumab wild-type RAS metastatic colorectal cancer