BACKGROUND: The ASPECCT trial was a phase 3 head-to-head randomized noninferiority study comparing the efficacy and safety of epidermal growth factor receptor inhibitors (anti-EGFRs), panitumumab and cetuximab, in patients with previously treated, chemotherapy resistant or intolerant, wild-type (WT) KRAS exon 2 metastatic colorectal cancer (mCRC). Trial results indicated similar median overall survival (OS; HR = 0.97, 95% CI: 0.84-1.11), and similar median progressionfree survival (PFS; HR = 1.00, 95% CI: 0.88-1.14). Given this similar efficacy, economic modeling may assist decision makers in determining the relative monetary value of one treatment versus another in a context of healthcare budgetary challenges and constraints.
OBJECTIVE: To compare the costs of treatment with panitumumab versus cetuximab among chemorefractory patients with WT KRAS mCRC.
METHODS: A cost-minimization model was developed based on similar treatment efficacy. The model estimated the costs associated with drug acquisition, treatment administration frequency (every 2 weeks for panitumumab, weekly for cetuximab), and incidence of infusion reactions. Average anti-EGFR doses were calculated from ASPECCT. Using the medical component of the consumer price index, adverse event costs were inflated to 2014 U.S. dollars, and all other costs were reported in 2014 U.S. dollars. The time horizon for the model was based on mean PFS, estimated from parametric survival analyses of ASPECCT data.
RESULTS: Relative to cetuximab in the treatment of chemotherapy resistant or intolerant patients with WT KRAS mCRC, the costminimization model estimated lower projected drug acquisition, administration, and adverse event costs for patients who received panitumumab. The overall cost per patient was $47,679 for panitumumab versus $59,630 for cetuximab, resulting in a per-patient savings of $11,952 (20%). Drug acquisition costs alone were 17% less with panitumumab ($46,179 vs. $55,963).
CONCLUSIONS: From a value perspective, the cost-minimization model supports panitumumab versus cetuximab as a preferred treatment option for chemorefractory WT KRAS mCRC patients.
