PCN91 Pharmacoeconomic Analysis of mCRC Therapy With XELOX/FOLFOX4 Regimes With Bevacizumab or Cetuximab as the First Line Treatment in Russia

Abstract

OBJECTIVES:To assess cost-effectiveness of rituximab (RTX) 1st line maintenance treatment compared to observation (O) in patients with follicular lymphoma (FL) from the Polish public payer perspective. METHODS: Efficacy and safety of rituximab 1st line maintenance therapy was assessed based on the results of systematic review and the PRIMA clinical trial. Direct medical costs were assessed based on the data regarding clinical practice of FL treatment and medical resources use gathered in 5 oncology centers. The following costs were calculated and included: drugs, drug administration, treatment-related adverse events, lymphoma relapse treatment, patient health monitoring. A life-time horizon (25 years) and public payer perspective were assumed. Costs were discounted at 5% and effects at 3.5%. A four health state Markov model (progression-free 1st line, progression-free subsequent line, progression and death) was used. Sensitivity analysis was performed testing the influence of various critical parameters such as utilities values, different costs categories, length of time horizon and patient's body surface. RESULTS: Introduction of 1st line maintenance therapy with RTX resulted in gain of 1.4 life years and 1.3 quality adjusted life years compared to observation. The total incremental costs were 60,707 PLN (1 EUROϭ3.96 PLN) which corresponded to an incremental cost-effectiveness ratio (ICER) of 43,348 PLN and an incremental cost-utility ratio (ICUR) of 47,357 PLN. Both values were below 110 000 PLN cost-effectiveness threshold assumed by the Polish public payer. The results were sensitive to discount rates, utilities values applied to the specific health states, length of time horizon. None of the tested scenarios resulted in values of ICUR and ICER exceeding the 110,000PLN threshold, providing evidence that rituximab treatment is costeffective from public payer perspective. CONCLUSIONS: Rituximab in 1st line maintenance treatment of FL is an effective, safe and cost -effective therapeutic option.