The Cost Study of First- line Treatment of Metastatic Colorectal Carcinoma with Bevacizumab- containing Regimen in the Czech Republic
Authors:
I. Hradecká 1; B. Říhová 1; R. Horová 2; Demlová R. 1 3
Authors‘ workplace:
Farmakologický ústav, LF MU, Brno
1; Oddělení klinických hodnocení, Masarykův onkologický ústav, Brno
2; Regionální centrum aplikované molekulární onkologie, Masarykův onkologický ústav, Brno
3
Published in:
Klin Onkol 2014; 27(4): 255-260
Category:
Original Articles
Overview
Background:
Bevacizumab, a humanized monoclonal IgG antibody against the vascular endothelial growth factor (VEGF), is reimbursed in combination with chemotherapy for the first and subsequent‑line treatment of patients with metastatic colorectal cancer (mCRC) in the Czech Republic. However, its high cost is a potentially limiting factor. We assessed the cost of bevacizumab in the treatment of mCRC in a comprehensive cancer center.
Patients and Methods:
A total of 218 patients were included in our analysis. Cost data (examination, medication, hospitalization) were collected since the initiation of bevacizumab treatment to any tumor response (RECIST criteria: complete response – CR, partial response – PR, stable disease – SD, progressive disease – PD) and/ or to death. Minimal follow‑up for all patients was 28 months. Costs were valued in Czech crowns (CZK) and converted to EUR (1€ = 25.14 CZK).
Results:
PD was recorded in 194 patients (89% of patients). The mean cost of treatment to PD (median TTP 9.1 months) was 1,002,076.30 CZK (39,859.84 EUR). The majority of costs to PD was made by medication – 917,048.60 CZK (36,477.67 EUR) per patient. The mean cost to response PR, CR or SD was 1,105,823.10 CZK (43,986.60 EUR) after median 9.8 months of treatment (recorded for 21 patients), medication formed 1,023,827.70 CZK (40,725.05 EUR). During the study, 170 patients (78%) died. The mean of the total costs since initiation of treatment to death (median OS 18.8 months) was 1,338,874.20 CZK (53,256.70 EUR) – out of that, medication was 1,184,251.10 CZK (47,106.25 EUR) per patient.
Conclusion:
Targeted biological therapy is the largest part of the costs of mCRC therapy. Cost of bevacizumab made up to 69% of costs to PD – 687,608.20 CZK ( 27,351.20 EUR ) per patient. The majority of the total cost was formed by targeted drug therapy (bevacizumab in 1st line therapy, cetuximab and panitumumab in 2nd and 3rd line therapy); 58% of total costs since initiation of treatment to death – 778,233.80 CZK (30,956 EUR) per patient.
Key words:
drug costs – targeted molecular therapy – bevacizumab – antineoplastic agents – colorectal neoplasms
The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.
The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.
Submitted:
9. 3. 2014
Accepted:
19. 5. 2014
Sources
1. Zvolský M (ed.). Zhoubné nádory v roce 2010. [citováno 18. prosince 2013]. Dostupné z: http:/ / www.uzis.cz/ rychle‑ informace/ zhoubne‑ nadory‑ roce‑ 2010.
2. Modrá kniha České onkologické společnosti, 18. vyd.Masarykův onkologický ústav 2014. [citováno 1. března 2014]. Dostupné z: http:/ / www.linkos.cz/ informace‑ pro‑praxi/ modra‑ kniha/ .
3. Pavlík T, Májek O, Dušek L (eds). Přežití a kvalita péče o pacienty s kolorektálním karcinomem. [citováno 1. března 2014]. Dostupné z: http:/ / www.kolorektum.cz/ index.php?pg=pro‑odborniky‑ ‑ preziti‑ a‑ kvalita‑ pece‑ o‑ pacienty‑ s‑ kolorektalni‑ karcinomem.
4. Grothey A. Optimální léčba metastazujícího kolorektálního karcinomu. [citováno 1. března 2014]. Dostupné z: http:/ / www.linkos.cz/ asco/ chapter/ optimalni‑ lecba‑ metastazujiciho‑ kolorektalniho‑ karcinomu/ .
5. Hurwitz H, Fehrenbacher L, Novotny W et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med 2004; 350(23): 2335– 2342.
6. Cutsem EV, Kohne CH, Hitre E et al. Cetuximab and chemotherapy as initial treatment for metastatic colorectal cancer. N Engl J Med 2009; 360(14): 1408– 1417. doi: 10.1056/ NEJMoa0805019.
7. Sukl.cz [internetová stránka]. Státní ústav pro kontrolu léčiv. Avastin, detail léčivého přípravku, ceny a úhrady, indikační omezení. [citováno 30. září 2013]. Dostupné z: http:/ / www.sukl.cz/ modules/ medication/ detail.php?code=0028397&tab=prices.
8. McCormack PL, Keam SJ. Bevacizumab: a review of its use in metastatic colorectal cancer. Drugs 2008; 68(4): 487– 506.
9. Ema.auropa.eu [homepage on the Internet]. Avastin product information. European Medicines Agency [cited 2013 Sep 30]. Available from: http:/ / www.ema.europa.eu/ ema/ index.jsp?curl=pages/ medicines/ human/ medicines/ 000582/ human_med_000663.jsp&mid=WC0b01ac058001d124.
10. Saltz LB, Clarke S, Díáz‑ Rubio E et al. Bevacizumab in combination with oxaliplatin‑based chemotherapy as first‑line therapy in metastatic colorectal cancer: a randomized phase iii study. J Clin Oncol 2008; 26(12): 2013– 2019. doi: 10.1200/ JCO.2007.14.9930.
11. Sobrero A, Ackland S, Clarke S et al. Phase IV study of bevacizumab in combination with infusional fluorouracil, leucovorin and irinotecan (FOLFIRI) in first‑line metastatic colorectal cancer. Oncology 2009; 77(2): 113– 119. doi: 10.1159/ 000229787.
12. Cutsem EV, Rivera F, Berry S et al. Safety and efficacy of first‑line bevacizumab with FOLFOX, XELOX, FOLFIRI and fluoropyrimidines in metastatic colorectal cancer: the BEAT study. Ann Oncol 2009; 20(11): 1842– 1847. doi: 10.1093/ annonc/ mdp233.
13. Stathopoulos GP, Batziou C, Trafalis D et al. Treatment of colorectal cancer with and without bevacizumab: a phase III study. Oncology 2010; 78(5– 6): 376– 381. doi: 10.1159/ 000320520.
14. Kocáková I, Kocák I, Svoboda M et al. Bevacizumab v kombinaci s kapecitabinem a irinotekanem (XELIRI) v léčbě metastatického kolorektálního karcinomu. Klin Onkol 2009; 22(2): 73– 76.
15. Garattini L, van de Vooren K, Zaniboni A. Ethics for end‑of‑life treatments: metastatic colorectal cancer is one example. Health Policy 2013; 109(1): 97– 103. doi: 10.1016/ j.healthpol.2012.08.017.
16. Uzis.cz [internetová stránka]. Ekonomické informace ve zdravotnictví 2012. Ústav zdravotnických informací a statistiky ČR 2012 [citováno 1. března 2014 ]. Dostupné z:http:/ / www.uzis.cz/ publikace/ ekonomicke‑ informace‑ ve‑ zdravotnictvi‑ 2012.
17. Sukl.cz [internetová stránka]. Státní ústav pro kontrolu léčiv. Hodnocení dodávek distribuovaných léčivých přípravků za rok 2012 [citováno 1. března 2014]. Dostupné z:http:/ / www.sukl.cz/ hodnoceni‑ dodavek‑ distribuovanych‑ lecivych‑ pripravku‑ za‑ rok‑ 2.
18. Kabbinavar FF, Hambleton J, Mass RD et al. Combined analysis of efficacy: the addition of bevacizumab to fluoro-uracil/ leucovorin improves survival for patients with metastatic colorectal cancer. J Clin Oncol 2005; 23(16): 3706– 3712.
19. Linkos.cz [internetová stránka]. Klinický registr CORECT [citováno 11. března 2014]. Dostupné z: http: http:/ / www.linkos.cz/ prehled‑ registru/ klinicky‑ registr‑ corect/ .
20. Sukl.cz [internetová stránka]. Státní ústav pro kontrolu léčiv. Dokumentace tvořící spis správních řízení, které se týkají stanovení maximální ceny, stanovení výše a podmínek úhrady. VaPÚ Avastin SUKLS85212/ 2008 [citováno 18. března 2013]. Dostupné z: www.sukl.cz.
21. Tappenden P, Jones R, Paisley S et al. The cost‑effectiveness of bevacizumab in the first‑line treatment of metastatic colorectal cancer in England and Wales. Eur J Cancer 2007; 43(17): 2487– 2494.
22. Hedden L, Kennecke H, Villa D et al. Incremental cost‑effectiveness of the pre‑ and post‑bevacizumab eras of metastatic colorectal cancer therapy in British Columbia, Canada. Eur J Cancer 2012; 48(13): 1969– 1976. doi: 10.1016/ j.ejca.2012.01.012.
23. Tilson L, Sharp C, Usher C et al. Cost of care for colorectal cancer in Ireland: a health care payer perspective. Eur J Health Econ 2012; 13(4): 511– 524. doi: 10.1007/ s10198‑ 011‑ 0325‑ z.
24. Shiroiwa T, Fukuda T, Tsutani K. Cost‑effectiveness analysis of bevacizumab combined with chemotherapy for the treatment of metastatic colorectal cancer in Japan. Clin Ther 2007; 29(10): 2256– 2267.
25. Lee EK, Revil C, Ngoh CA et al. Clinical and cost effectiveness of bevacizumab + FOLFIRI combination versus FOLFIRI alone as first‑line treatment of metastatic colorectal cancer in South Korea. Clin Ther 2012; 34(6): 1408– 1419. doi: 10.1016/ j.clinthera.2012.05.001.
26. Pavlík T, Májek O, Mužík J et al. Estimating the number of colorectal cancer patients treated with anti‑tumour therapy in 2015: the analysis of the Czech National Cancer Registry. BMC Public Health 2012; 12(1): 117. doi: 10.1186/ 1471‑ 2458‑ 12‑ 117.
Labels
Paediatric clinical oncology Surgery Clinical oncologyArticle was published in
Clinical Oncology
2014 Issue 4
Most read in this issue
- Brazilian Story of the R337H p53 Mutation
- Acupuncture in the Treatment of Symptoms of Oncological Diseases in the Western World
- Paraneoplastic Vasculitis in a Patient with Cervical Cancer
- Screening of Malnutrition Risk Versus Indicators of Nutritional Status and Systemic Inflammatory Response in Newly Diagnosed Lung Cancer Patients