Economic evaluation of monoclonal antibody in the management of colorectal cancer

Abstract

Objective: This study aims to determine the cost of colorectal cancer (CRC) management and compare the cost effectiveness of cetuximab and bevacizumab in the management of CRC. Method: This economic evaluation study from a societal perspective involves collecting resource utilization data based on the clinical pathway of colorectal cancer management. The cost calculated includes drugs, human resources, administrative, investigations as well as capital cost. Patient's cost was also calculated based on an interview with colorectal cancer patients. Effectiveness estimates for monoclonal antibody (cetuximab and bevacizumab) treatment were modeled from study respondents based on references from other studies. Results: Cost of treating a case of colorectal cancer in stage I is RM13,623 (RM12,467-RM14,777), stage II RM19,753 (RM16,734-RM23,520), stage III RM24,972 (RM20,291-RM29,654) and stage IV RM27, 163 (RM23, 192-RM31,133). Cost of CRC management increase with the increasing stage of the disease (Kruskal Wallis, X2=106, p<0.001). Based on estimates of 2671 new cases of CRC, the incremental cost of cetuximab is RM20, 556 480 and bevacizumab is RM7,557,953 at 50% stage III and IV as compared to the conventional chemotherapy. The incremental cost per quality adjusted life years gained for cetuximab is RM38,869 and RM14,290 for bevacizumab. Although both types of monoclonal antibody are considered cost effective (based on WHO guidelines of less than three times of GDP), bevacizumab is considered more cost effective than cetuximab. Cost effectiveness was sensitive to the percentage of late stages of CRC. Conclusions: Cost of treating late stage of CRC is high and bevacizumab are more cost effective compared to cetuximab in the management of the late stage of CRC.

Cost-effectiveness of FOLFOX6+Bevacizumab Versus FOLFOX6+Cetuximab in Stage IV Colorectal Cancer Patients in Shiraz, Iran

“…The results of the studies by Elsamanyet al (2021) 64 and Lange et al (2014) 33 also indicated that the drug regimen containing Cetuximab had higher cost-utility. However, the results of the studies by Ezatet al (2013) 62 and Natrah et al (2012) from the societal perspective 63 showed that Bevacizumab was cheaper and with higher utility. The reason for the difference between the results of these 2 and other studies could be attributed to the type of drugs and drug combinations compared.…”

“…The results of the studies by Lee et al (2021) with the societal perspective 51 and Koilakou et al (2021) 61 showed that the drug regimen containing Cetuximab was more costeffective. However, the results of the studies by Najafi et al (2018) from the perspective of the health system, 56 Ezatet al (2013) from the societal perspective, 62 and Natrah et al (2012) 63 from the societal perspective showed that Bevacizumab was more cost-effective in the management of laststage colorectal cancer. The reasons for the difference between the results of this study and other studies could be attributed to the types of drugs compared and the investigation of only direct medical costs in some other studies.…”

Comprehensive Analysis of microRNA Methylation Profiles and Determination of Their Functional Significance in Colorectal Cancer: A Study Protocol

“…The impact of this issue is not limited to individuals, as it also puts a significant economic burden on healthcare systems. The cost of managing new CRC cases is estimated at RM62 million annually [1] . While there have been considerable improvements in diagnostic procedures and patient care, numerous obstacles remain.…”

“…While there have been considerable improvements in diagnostic procedures and patient care, numerous obstacles remain. These involve early diagnosis, pinpointing prognostic factors, devising effective treatments for metastatic conditions, and tailoring treatment strategies to individual patients [1,2] . A local study highlighted the high cost of CRC, indicating that provider costs range from RM13,672 for stage I to RM27,972 for stage IV [3] .…”

Genome-Wide Open Chromatin Methylome Profiles in Colorectal Cancer

“…In addition, there is a shift in its incidence towards younger patients who are diagnosed with advanced forms of cancer [4]. Furthermore, the cost associated with CRC management increase with the increasing stage of the disease [5] and will pose a great burden to the health sector. Further understanding of the epigenetic components in the processes involved in CRC carcinogenesis is highly desired and will unravel new biomarkers which can be utilized for diagnosis, prognosis and treatment to prevent CRC-related mortality.…”