HEALTH ECONOMIC EVALUATION OF BIOLOGIC AGENTS FOR METASTATIC COLORECTAL CANCER PATIENTS IN BRAZIL

Objectives: To evaluate the cost-effectiveness of different treatment strategies for metastatic colorectal cancer (mCRC) in the Brazilian public health system (SUS). Methods: We built a Markov model to analyze costs and impacts of the incorporation of cetuximab (CET) or bevacizumab (BEV) to standard therapy (FOLFOX and FOLFIRI), over a time horizon of 10 years. Depending on KRAS status, the patients were assumed to receive one of these sequential schedules: (1) FOLFOX ® FOLFIRI; (2) FOLFIRI± CET ® FOLFOX + BEV; (3) FOLFIRI + CET or BEV ® FOLFOX; and (4) FOLFIRI + BEV ® FOLFOX + BEV ® Irinotecan ± CET. Efficacy data were derived from randomized clinical trials and treatment costs from price tables issued by the Health Ministry. Sensitivity analyses were undertaken to explore uncertainty. Adoption of infusion pumps was investigated as an alternative strategy. Results: Compared to chemotherapy, the incorporation of the CET and BEV resulted in an incremental effectiveness ranging from 23 to 32 life years, and a considerable cost differences, as total costs ranged from US$ 30,053 to around US$96,020. Strategy 2 resulted in an incremental cost-effectiveness ratio of US$182,617 compared to standard therapy, which far exceeds the pre-specified threshold for cost-effectiveness (U$28,715) considered. Strategies 3 and 4 were dominated by strategy 2 Acquisition of biological agents was the principal driver of the cost difference. Adopting an infusion pump for use at home for 100% of patients could reduce around 45% of the total costs of chemotherapy. Conclusions: From the SUS perspective, and at current prices, biologic agents are not cost-effective for the treatment of mCRC. Chemotherapy continues to be the most cost-effective approach. Home infusion should be promoted to be the standard of care for Brazilian mCRC-patients.