Cost-Effectiveness of Cetuximab As First-Line Treatment for Metastatic Colorectal Cancer in the United States

To evaluate the clinical and economic tradeoffs associated with FOLFIRI + either cetuximab or bevacizumab as 1st-line therapies among KRAS wild type (WT) metastatic colorectal cancer (mCRC) patients, through a cost-effectiveness analysis incorporating Phase III FIRE3 clinical trial data. A deterministic cost-effectiveness model was developed to project lifetime survival and costs of FOLFIRI used with either cetuximab or bevacizumab. A cohort of 1st-line patients faced risks of adverse events, progression to 2nd-line treatment, or eligibility for curative liver resection. Clinical trial data, published literature, and publicly available databases were used to estimate model inputs. Incremental cost-effectiveness ratios (ICERs) were calculated as 2013 US$ per life year (LY) and per quality-adjusted life year (QALY). We conducted a scenario analysis to analyze the subset of RAS WT patients. The impact of parameter uncertainty was also evaluated with one-way and probabilistic sensitivity analyses. Compared with 1st-line bevacizumab KRAS WT patients, those treated with cetuximab gained an additional 5.7 months of life (42.9 vs. 37.2) at a cost of $46,301 ($280,933 vs. $234,632), for an ICER of $97,297/LY ($122,704/QALY). The benefits of cetuximab were also greater for RAS WT patients, for whom the ICER was $77,380/LY ($99,636/QALY). Treatment with cetuximab would be cost effective 53.6% of the time, given a willingness to pay threshold of $100,000/LY. Results were most sensitive to changes in 1st-line survival, treatment duration, and product acquisition costs. Treatment with cetuximab + FOLFIRI in 1st-line mCRC patients may improve health outcomes and use financial resources more efficiently than bevacizumab + FOLFIRI, given current societal standards. This information can be useful to clinicians, payers, and policy makers in making treatment and resource allocation decisions for KRAS WT and RAS WT mCRC patients.