Sequenciamento de biológicos em câncer colorretal metastático (CCRm): uma análise de comparação de custos para pacientes CCRm RAS selvagens no Brasil

Abstract

Sequential biological therapies in metastatic colorectal cancer (mCRC): a cost comparison analysis for wildtype RAS mCRC patients in Brazil ABSTRACTObjective: To compare the treatment costs of different sequences of regimens including monoclonal antibodies in metastatic colorectal cancer (CRCm) treatment for the Brazilian Supplementary Healthcare System. Methods: Sixteen scenarios were analyzed, each one comparing a sequence of bevacizumab TML plus an anti-EGFR therapy in the third-line with another sequence without bevacizumab TML (non-Bev TML) in patients with CRCm wild-type RAS. The anti-EGFRs cetuximab and panitumumab were included. The monthly and total costs of the therapeutic sequences were compared per patient. Results: The sequences with Bev TML were cost-saving in 50% of all scenarios, and especially observed over regimens starting with cetuximab in the first-line treatment. Regarding scenarios which the non-Bev TML sequences were less costly, they all started with bevacizumab followed by an anti--EGFR biologic drug. Conclusion: The Bev TML regimens were cost-saving compared to scenarios of non-Bev TML which started with cetuximab, and sequential use of bevacizumab beyond progression and the addition of an anti-EGFR biologic drug in the third-line for mCRC treatment. Considering the remaining scenarios in which Bev-TML was not cost-saving, those starting with Bev presented lower costs in total. Therefore, starting a treatment with bevacizumab seems to enable a more rational management of resource usage, as well as, to allow physicians to add a biologic drug in the third-line, potentially enhancing the long term management of wild-type RAS mCRC. RESUMOObjetivo: Comparar o custo de tratamento de diferentes sequências de regimes incluindo anticorpos monoclonais no tratamento de câncer colorretal metastático (CCRm) no Sistema de Saúde Suplementar Brasileiro. Métodos: Dezesseis cenários foram analisados, cada um comparando uma sequência de bevacizumabe TML (Bev TML) mais um anti-EGFR em terceira linha, com outra sequên-cia sem bevacizumabe TML (não-Bev TML). Os anti-EGFRs cetuximabe e panitumumabe forma incluídos. Os custos mensais e totais do sequenciamento terapêutico foram comparados por pacientes. Resultados: As sequências com Bev TML trouxeram economia de recursos em 50% de todos os cenários, e especialmente comparado aos regimes iniciando com cetuximabe em primeira linha de tratamento. Considerando os cenários em que os regimes não-Bev TML apresentaram menos custo, todos iniciaram o sequenciamento com bevacizumabe seguido de um medicamento biológico anti-EGFR. Conclusões: Os regimes Bev TML apresentaram economia de recursos comparado aos cenários com não-Bev TML que iniciaram com cetuximabe, apesar do uso de bevacizumabe em múltiplas linhas e da adição de medicamento biológico anti-EGFR em terceira linha no tratamen- Keywords

Association of KRAS G12C Status with Age at Onset of Metastatic Colorectal Cancer

“…Adequate information about the molecular status of mCRC patients has an impact on the clinical decision-making process for oncologists, as appointed by a nation-wide survey conducted by the Brazilian Group of Gastrointestinal Tumors [33]. In addition, the knowledge generated by our study could help health care authorities to develop a more efficient administration of resources in Brazil, as demonstrated in a cost-comparison analysis of sequential therapies in the Brazilian population [34].…”