Bevacizumab treatment in metastatic colorectal carcinoma – an economic perspective

Czech version

Authors: Irena Sehnalová; Barbora Říhová; Regina Demlová
Published in: Čes. slov. Farm., 2019; 68, 43-47
Category: Review Articles

Overview

Targeted therapy is a significant benefit in the treatment of cancer patients. Bevacizumab improves overall survival (OS) and progression free survival (PFS) in the treatment of metastatic colorectal cancer (mCRC). The clinical effectiveness of bevacizumab is similar to its efficacy in randomised controlled trials. However, the costs of bevacizumab treatment as well as other agents of targeted treatment are discussed between the health care payers, the regulatory authorities and the members of professional societies. Biomarkers of bevacizumab treatment helpful in the selection of eligible groups of patients are still missing. This review focuses on current bevacizumab therapy of mCRC from the pharmacoeconomic perspective. The cost per a 14-day
bevacizumab treatment cycle is approximately 31,000 CZK in the Czech Republic. External published pharmacoeconomics analyses have no clear conclusions. Their results are usually expressed as the cost per QALY gained in comparison with a comparator. They differ according to the economic situation of the particular countries. The pharmacoeconomic results have to be confirmed in the real clinical practice, and then the decision should be reassessed by using the uniform methodology, e.g. the Health Technology Assessment (HTA).

Keywords:

bevacizumab – targeted biological therapy – QALY – metastatic colorectal cancer

Sources

1. van Cutsem E., Cervantes A., Adam R., et al. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol. 2016; 27(8), 1386–422. doi.org/10.1093/annonc/mdw235

2. Ústav zdravotnických informací a statistiky ČR. Novotvary 2016. Available from: http://www.uzis.cz/katalog/zdravotnicka-statistika/novotvary (accessed on 10. 3. 2019).

3. Vyzula R. Modrá kniha České onkologické společnosti. Brno 2018. Available from: http://www.linkos.cz/informace-pro-praxi/modra-kniha/ (accessed on 10. 3. 2019).

4. Giantonio B. J., Catalano P. J., Meropol N. J., et al. Bevacizumab in Combination With Oxaliplatin, Fluorouracil, and Leucovorin (FOLFOX4) for Previously Treated Metastatic Colorectal Cancer: Results From the Eastern Cooperative Oncology Group Study E3200. J. Clin. Oncol. 2007; 25(12), 1539–1544. doi:10.1200/JCO.2006.09.6305

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. doi:10.1056/NEJMoa032691

6. Douillard J. Y., Siena S., Cassidy J., et al. Final results from PRIME: randomized phase III study of panitumumab with FOLFOX4 for first-line treatment of metastatic colorectal cancer. Ann Oncol. 2014; 25(7), 1346–1355. doi.org/10.1093/annonc/mdu141

7. Bokemeyer C., Bondarenko I., Hartmann J. T., et al. Efficacy according to biomarker status of cetuximab plus FOLFOX-4 as first-line treatment for metastatic colorectal cancer: the OPUS study. Ann Oncol. 2011; 22(7), 1535–1546. doi.org/10.1093/annonc/mdq632

8. Cutsem E. V., Tabernero J., Lakomy R., et al. Addition of Aflibercept to Fluorouracil, Leucovorin, and Irinotecan Improves Survival in a Phase III Randomized Trial in Patients With Metastatic Colorectal Cancer Previously Treated With an Oxaliplatin-Based Regimen. J. Clin. Oncol. 2012; 30(28), 3499–3506. doi:10.1200/JCO.2012.42.8201

9. Cutsem E. V., Köhne C.-H., Láng I., et al. Cetuximab Plus Irinotecan, Fluorouracil, and Leucovorin As First-Line Treatment for Metastatic Colorectal Cancer: Updated Analysis of Overall Survival According to Tumor KRAS and BRAF Mutation Status. J. Clin. Oncol. 2011; 29(15), 2011–2019. doi:10.1200/JCO.2010.33.5091

10. Grothey A., Cutsem E. V., Sobrero A., et al. Regorafenib monotherapy for previously treated metastatic colorectal cancer (CORRECT): an international, multicentre, randomised, placebo-controlled, phase 3 trial. Lancet 2012; 381(9863), 303–312. doi.org/10.1016/S0140-6736(12)61900-X

11. Aghagolzadeh P., Radpour R. New trends in molecular and cellular biomarker discovery for colorectal cancer. World J. Gastroenterol. 2016; 22(25), 5678–5693. doi:10.3748/wjg.v22.i25.5678

12. Státní ústav pro kontrolu léčiv. Vectibix, detail léčivého přípravku, ceny a úhrady, indikační omezení. Available from: http://www.sukl.cz/modules/medication/detail.php?code=0029248&tab=
texts (accessed on 10. 3. 2019).

13. Státní ústav pro kontrolu léčiv. Erbitux, detail léčivého přípravku, ceny a úhrady, indikační omezení. Available from: http://www.sukl.cz/modules/medication/detail.php?code=0028761&tab=
prices (accessed on 10. 3. 2019).

14. Hurwitz H. I., Yi J., Ince W., Novotny W. F., et al. The clinical benefit of bevacizumab in metastatic colorectal cancer is independent of K-ras mutation status: analysis of a phase III study of bevacizumab with chemotherapy in previously untreated metastatic colorectal cancer. The Oncologist. 2009; 14(1): 22–28. doi:10.1634/theoncologist.2008-0213

15. Linkos. Klinický registr CORECT. Available from: http://www.linkos.cz/prehled-registru/klinicky-registr-corect/ (accessed on 12. 2. 2019).

16. Cutsem E. V., 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.org/10.1093/annonc/mdp233

17. Státní ústav pro kontrolu léčiv. Avastin, detail léčivého přípravku, ceny a úhrady, indikační omezení [Internet]. Available from: http://www.sukl.cz/modules/medication/detail.php?code
=0028396&tab=prices (accessed on 10. 2. 2019).

18. Hradecká I., Ríhová B., Horová R., et al. The cost study of first- line treatment of metastatic colorectal carcinoma with bevacizumab- containing regimen in the Czech Republic]. Klin. Onkol. 2014; 27(4), 255–260.

19. Goldstein D. A., Chen Q., Ayer T., et al. First- and second-line bevacizumab in addition to chemotherapy for metastatic colorectal cancer: A United States-based cost-effectiveness analysis. J. Clin. Oncol. 2015; 33(10), 1112–1118. doi:10.1200/JCO.2014.58.4904

20. 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. doi.org/10.1016/j.ejca.2007.08.017

21. Jain S., Shankaran V. The Economics of personalized therapy in metastatic colorectal cancer. Curr Colorectal Cancer Rep. 2016; 12(3), 123–129. doi.org/10.1080/14737167.2016.1259070

22. Lawrence D., Maschio M., Leahy K. J., et al. Economic analysis of bevacizumab, cetuximab, and panitumumab with fluoropyrimidine-based chemotherapy in the first-line treatment of KRAS wild-type metastatic colorectal cancer (mCRC). J. Med. Econ. 2013; 16(12), 1387–1398. doi.org/10.3111/13696998.2013.852097

23. Fínek J., Skoupá J., Jandová P. Cost-effectiveness analysis of panitumumab plus mFOLFOX6 compared to bevacizumab plus mFOLFOX6 for first-line treatment of patients with wild-type RAS metastatic colorectal cancer – Czech Republic model adaptation. Klin Onkol. 2015; 28(4), 265–272.

24. Shankaran V., Mummy D., Koepl L., et al. Survival and lifetime costs associated with first-line bevacizumab use in older patients with metastatic colorectal cancer. The Oncologist August 2014; 19(8), 892–899.

25. Büchler T., Melichar B., Vrána D., et al. Evaluation of anti-cancer therapies with reimbursement limited to comprehensive cancer centres using the European Society for Medical Oncology Magnitude of Clinical Benefit Scale. Klin. Onkol. 2017; 30(5): 349–360.

26. EUnetHTA Joint Action 2, Work Package 8. HTA Core Model ® version 3.0 (Pdf); 2016. Available from: www.htacoremodel.info/BrowseModel.aspx (accessed 10. 2. 2019).

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Article was published in

Czech and Slovak Pharmacy

2019 Issue 2