Model-Based Cost-Effectiveness Analysis of Panitumumab Plus FOLFIRI for the Second-Line Treatment of Patients with Wild-Type Ras Metastatic Colorectal Cancer

Adv Ther. 2020 Feb;37(2):847-859. doi: 10.1007/s12325-019-01214-y. Epub 2020 Jan 4.

Abstract

Introduction: The NCT00339183 trial demonstrated that adding panitumumab to fluorouracil, leucovorin and irinotecan (FOLFIRI) as a second-line therapy of wild-type RAS metastatic colorectal cancer (mCRC) increases the median progression-free survival (PFS). Nevertheless, panitumumab is not yet approved in China, and the costs and outcomes of the therapy are still unclear. We estimated the cost-effectiveness of this intervention from the perspective of Chinese health care systems by constructing two pricing scenarios for panitumumab. Scenario 1: Pricing is based on the price of a similar product (cetuximab) in China. Scenario 2: We estimated the value-based price.

Methods: A partitioned survival model was created based on the results of the NCT00339183 trial, which evaluated panitumumab plus FOLFIRI versus FOLFIRI. The model simulated the disease progression. We calculated medical costs from the perspectives of the Chinese health care systems. The primary outcome measures were costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs).

Results: In scenario 1, compared with FOLFIRI alone, FOLFIRI with panitumumab arm had an ICER of ¥1,539,988/QALY. The most influential factors were the mean overall survival (OS), utility before progression and cost of panitumumab. The probability of panitumumab plus FOLFIRI being cost-effective in China was 0% when the willingness-to-pay (WTP) threshold was ¥193,932/QALY. In scenario 2, when the cost of panitumumab was assumed to be ¥4032.61 or ¥5218.96 per cycle, the ICERs approximated the WTP thresholds of ¥193,932/QALY or ¥420,633/QALY, respectively. In this value-based pricing scenario, panitumumab plus FOLFIRI is estimated to be cost-effective.

Conclusion: We construct two pricing scenarios in China. In scenario 1, panitumumab plus FOLFIRI as a second-line therapy of mCRC provided an incremental benefit, but simultaneously increased costs (at the current price) even further. In scenario 2, when the value-based price was adopted, panitumumab plus FOLFIRI was estimated to be cost-effective. Our study establishes a pricing framework for new anticancer drugs to reflect the economics of drugs.

Trial registration number: NCT00339183.

Keywords: Cost-effectiveness; Metastatic colorectal cancer; Panitumumab; Partitioned survival model.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents, Immunological / economics
  • Antineoplastic Agents, Immunological / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols / economics*
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Camptothecin / analogs & derivatives*
  • Camptothecin / therapeutic use
  • Cetuximab / economics
  • Cetuximab / therapeutic use
  • China
  • Colorectal Neoplasms / drug therapy*
  • Colorectal Neoplasms / economics*
  • Cost-Benefit Analysis / statistics & numerical data
  • Female
  • Fluorouracil / economics
  • Fluorouracil / therapeutic use
  • Humans
  • Leucovorin / economics
  • Leucovorin / therapeutic use
  • Male
  • Middle Aged
  • Neoplasm Metastasis / drug therapy
  • Panitumumab / economics*
  • Panitumumab / therapeutic use*
  • Quality-Adjusted Life Years

Substances

  • Antineoplastic Agents, Immunological
  • Panitumumab
  • Cetuximab
  • Leucovorin
  • Fluorouracil
  • Camptothecin

Associated data

  • ClinicalTrials.gov/NCT00339183
  • figshare/10.6084/m9.figshare.11370840