Sequential Bevacizumab-based therapy in metastatic colorectal cancer (mCRC): results of a treatment sequencing cost analysis. P192.

Abstract

Background: The phase III ML 18147 study demonstrated that second line (2L) bevacizumab (BEV) plus standard “crossover” chemotherapy (CT) improves overall survival and progression free survival in patients previously exposed to first line (1L) BEV plus standard CT (fluoropyrimidine + irinotecan or oxaliplatin). This potentially impacts current clinical treatment algorithms; therefore it is important to compare the costs of different 1L → 2L → 3L sequences. Method: A Treatment Sequencing Costing tool was developed to compare sequence costs from a national payer perspective for the base case country Germany. Drug acquisition costs (WINAPO SQL, Lauer Taxe, March 2012) and administration costs (Kassenärztliche Bundesvereinigung, Einheitlicher Bewertungsmaßstab, V01, Quartal 2012) were included in the analysis. Calculations were based on proxy treatment durations of 6.1 months (1L), 4.0 months (2L) and 2.7 months (3L). Drug regimens were obtained from ML18147 study protocol (1L BEV→2L BEV) and standard practice (EMA labels, expert opinion, clinical trials). Results: Second line BEV-containing regimens in patients previously exposed to 1L BEV plus standard CT results in a gain in overall survival associated with a total incremental cost per patient (10.1 months treatment duration (mo td)) ranging from €10,077–€10,919 compared to 1LBEV+CT→CT alone sequences. Clinical practice sequences including all molecular agents starting with an anti-EGFR in accordance with the CRYSTAL trial incur a total treatment cost of €66,399 [cetuximab(cet) 400/250 mg/m2 +FOLFIRI→BEV 10mg/kg+FOLFOX]. In comparison, adding 3L anti-EGFR compound to sequential 1LBEV→2LBEV, results in a total treatment cost (12.8 mo td), ranging from €60,419 [BEV 5 mg/kg+FOLFOX→BEV 5mg/kg+FOLFIRI→pan 6mg/kg] to €64,739 [BEV 7.5mg/kg+XELOX→BEV 5 mg/kg+FOLFIRI→cet 500 mg/m2 +Irinotecan 180mg/m2 ]. Conclusion: Second line BEV-containing regimens in mCRC patients previously exposed to 1L BEV+CT results in a gain in overall survival at an expected incremental cost of approximately €11,000 per patient lifetime. For KRAS wild type patients, the integration of anti-EGFRs as 3L after 1LBEV→2LBEV results in availability of a further treatment line and is potentially cost saving compared to regimens where anti-EGFRs are administered upfront. Disclosure: Tamlyn Rautenberg: Advisory Role: Durchführung der Studie im Auftrag der F. Hoffmann-La Roche. Charles Ngoh: Employment or Leadership Position: Angestellter der F. Hoffmann-La Roche AG.