Objective: To compare the cost-effectiveness of panitumumab plus mFOLFOX6 (oxaliplatin, 5-fluorouracil and leucovorin) versus bevacizumab plus mFOLFOX6 as first-line treatment for patients with wild-type RAS metastatic colorectal cancer (mCRC).
Methods: Using a French health collective perspective, a lifetime Markov model was constructed, with health states related to first-line therapy (progression-free), disease progression with/without subsequent active treatment, resection of metastases, disease-free after successful resection, and death. Transitions to disease progression and death were estimated using parametric survival analyses of patient-level progression-free (PFS) and overall (OS) survival from the only head-to-head clinical trial of panitumumab versus bevacizumab in mCRC (PEAK). Additional data from PEAK informed the amount of each drug consumed, duration of therapy, subsequent therapy use, and toxicities related to mCRC treatment. Literature and French public data sources were used to estimate unit costs associated with treatment, duration of subsequent active therapies, and survival post-resection. Patient-level data from panitumumab trials in the first-, second-, and third-line settings were used to determine utility weights. One-way and probabilistic sensitivity analyses were performed. Scenario analyses examined modelling of PFS and OS using observational survival data and PEAK hazard ratios.
Results: Based on the better efficacy outcomes for patients with wild-type RAS mCRC who received panitumumab plus mFOLFOX6 versus bevacizumab plus mFOLFOX6 in PEAK, the incremental cost per life-year gained was estimated to be €26,918, and the incremental cost per quality-adjusted life year (QALY) gained was estimated to be €36,577. Sensitivity and scenario analyses indicate the model is robust to alternative parameters and assumptions.
Conclusions: Panitumumab plus mFOLFOX6 can be considered cost-effective in first-line treatment of patients with wild-type RAS mCRC.