Cost of Drugs for Metastatic CRC Per Month of Life Gained Vary Widely in Spain

Barcelona, Spain—According to data being presented at the ESMO 21st World Congress on Gastrointestinal Cancer, a wide variation exists in the cost per month of life gained for drugs administered in different lines of therapy for metastatic colorectal cancer (mCRC), with bevacizumab in the first-line more costly than the addition of EGFR inhibitors.

“[Despite CRC] treatment improvements, high increases in costs is a main concern. Therefore, a thorough assessment of the cost of drugs is necessary for a rational decision-making process,” explained lead investigator José M. Viéitez de Prado, MD, Medical Oncology, MD Anderson, Madrid, Spain, and colleagues.

Dr Viéitez de Prado et al randomized eligible articles of phase 2/3 trials that demonstrated a statistically significant positive gain in survival to analyze cost. Ultimately, there were 11, 9, and 8 articles selected to assess the first, second, and third lines of treatment, respectively.

The formula they used was cost/mg*mg/treatment cycle*median treatment/months of life gained (MLG). Cost per mg was calculated using a list of prices from the Official Chambers of Spanish Pharmacists Bot PLUS website, and cost per MLG was calculated for a patient of body surface area (BSA) 1.72 (66 Kg) and 1.80 (75 Kg).

When bevacizumab was added to first-line therapy, the cost per MLG was between €4798 and 5453 (BSA 1.72; BSA 1.8), whereas adding cetuximab and panitumumab had a cost per MLG of between €2582 and 2,702 (BSA 1.72; BSA 1.8) and €2713 and 3083 (BSA 1.72; BSA 1.8), respectively.

With regard to second-line therapy, bevacizumab was tied to a cost per MLG between €2045 and 2324 (BSA 1.72; BSA 1.80) and €6283 and 7139 (BSA 1.72, BSA 1.80), whereas ramucirumab demonstrated a cost per MLG that was between €17,400 and 19,773 (BSA 1.70; BSA 1.80) and €27,187 and 30,895 (BSA 1.72, BSA 1.80). In addition, aflibercept cost between €8071 and 9171.

“To our knowledge, for Cetuximab in 2nd line and there is no phase 2/3 study showing a statistically positive survival gain, therefore no cost was calculated,” Dr Viéitez de Prado and his co-investigators said.

Of note, the 4 drugs approved for use in the treatment of patients with mCRC in the third line (ie, regorafenib, trifluridine/tipiracil, cetuximab, and panitumumab) were associated with a costs per MLG of €6400; between €2373 and 2483 (BSA 1.72; BSA 1.80) and €3032 and 3173 (BSA 1.72; BSA 1.80); between €2709 and 2835; and between €4402 and 5002 (BSA 1.72; BSA 1.8), respectively.

“There is wide variation in the cost/MLG of drugs among the different lines of treatments in mCRC. The addition of Bevacizumab to a 1st line of treatment is more costly than the addition of EGFR inhibitors,” Dr Viéitez de Prado and colleagues concluded.—Hina Khaliq

Vieitez de Prado J, Encinas García S, Grande Pulido E, et al. Cost of metastatic colorectal cancer drugs per month of life gained in Spain. Presented at: the ESMO 21st World Congress on Gastrointestinal Cancer; July 3-6, 2019; Barcelona, Spain. Abstract P-040.