Health technology assessment of colorectal cancer chemotherapy with afl ibercept
Colorectal cancer (CRC) is an actual medical problem of the Russian Health Care system due to high morbidity and mortality rates. Despite the arrival of newer anti-cancer agents in the second-line setting for CRC treatment during the last years, no Health Technology Assessments (HTA) were preformed...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | Russian |
| Published: |
Izdatelstvo OKI
2018-05-01
|
| Series: | Качественная клиническая практика |
| Subjects: | |
| Online Access: | https://www.clinvest.ru/jour/article/view/109 |
| Summary: | Colorectal cancer (CRC) is an actual medical problem of the Russian Health Care system due to high morbidity and mortality rates. Despite the arrival of newer anti-cancer agents in the second-line setting for CRC treatment during the last years, no Health Technology Assessments (HTA) were preformed for modern agents. Aim: HTA of second line chemotherapy for metastatic CRC (mCRC) with a new anti-cancer agent afl ibercept in combination with chemotherapy regimen FOLFIRI during the short- and long-term perspectives for the Government Health Care System. Methods. Markov’s modelling has been performed based on published data of VELOUR study with 30-months horizon for two strategies of treatment: afl ibercept+FOLFIRI and FOLFIRI only for prognosis of effi cacy establishing. Overall survival (OS), time to progression (TTP) and QALY were used for effi cacy criteria defi nition. Cost-eff ectiveness analysis, including incremental, has been performed and results were compared with willingness to pay (WTP) parameter. Cost of chemotherapy, side eff ects correction, as well as expenditures for treatment in case of second line failure, have been calculated for both technologies. Costs were allowed by Governmental Health Care System expenditures. Results. It was concluded that afl ibercept+FOLFIRI is more eff ective vs FOLFIRI on all parameters of effi cacy (for OS — by 12%, for TTP — by 16%, for QALY — by 26%). CER`s for OS parameter were RUR 322 348 for afl ibercept+FOLFIRI and RUR 253 685 for FOLFIRI only (NS). For TTP parameter based on 30-months horizon ICER for afl ibercept+FOLFIRI was RUR 994 039, it was 1,35 times less than WTP. ICER for QALY was diff erent from such kind for OS and TTP. Total expenditures for 30-months modelling horizon for FOLFIRI were less by 42% due to add of afl ibercept cost in the calculation. Cost of treatment in case of second line failure was 78% of the total structure of expenditures for FOLFIRI and only 56% for afl ibercept+FOLFIRI. Probabilistic sensitivity analysis has been performed by multiplex changes of effi cacy parameters and costs of afl ibercept+FOLFIRI and FOLFIRI only and has confi rmed that afl ibercept+FOLFIRI is more eff ective and more expensive scheme. Conclusion. Second line strategy of mCRC chemotherapy with afl ibercept+FOLFIRI is more cost-eff ective vs FOLFIRI for OS and TTP criteria. When compared with afl ibercept+FOLFIRI, with FOLFIRI use, the treatment costs rise as a result of decreased effi cacy. Afl ibercept+FOLFIRI meets the criteria of WTP and is reasonable for reimbursement on Governmental level. |
|---|---|
| ISSN: | 2588-0519 2618-8473 |