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Real-World Cost Effectiveness of a Policy of KRAS Testing to Inform Cetuximab or Panitumumab for Third-Line Therapy of Metastatic Colorectal Cancer in British Columbia, Canada

Author

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  • Reka E. Pataky

    (Canadian Centre for Applied Research in Cancer Control, Cancer Control Research, BC Cancer
    University of British Columbia
    BC Cancer Research Centre)

  • Stirling Bryan

    (University of British Columbia
    Vancouver Coastal Health Research Institute)

  • Mohsen Sadatsafavi

    (University of British Columbia)

  • Stuart Peacock

    (Canadian Centre for Applied Research in Cancer Control, Cancer Control Research, BC Cancer
    Simon Fraser University)

  • Dean A. Regier

    (Canadian Centre for Applied Research in Cancer Control, Cancer Control Research, BC Cancer
    University of British Columbia)

Abstract

Background Cetuximab and panitumumab, two anti-EGFR therapies, are widely used for third-line therapy of metastatic colorectal cancer (mCRC) with wild-type KRAS, but there remains uncertainty around their cost effectiveness. The objective of this analysis was to conduct a real-world cost-effectiveness analysis of the policy change introducing KRAS testing and third-line anti-EGFR therapy mCRC in British Columbia (BC), Canada. Methods We conducted secondary analysis of administrative data for a cohort of mCRC patients treated in BC in 2006–2015. Patients potentially eligible for KRAS testing and third-line therapy after the policy change (July 2009) were matched 2:1 to pre-policy patients using genetic matching on propensity score and baseline covariates. Costs and survival time were calculated over an 8-year time horizon, with bootstrapping to characterize uncertainty around endpoints. Cost effectiveness was expressed using incremental cost-effectiveness ratios (ICER) and the probability of cost effectiveness at a range of thresholds. Results The cohort included 1757 mCRC patients (n = 456 pre-policy and n = 1304 post-policy; of those, n = 420 received cetuximab or panitumumab). There was a significant increase in survival and cost following the policy change. Adoption of KRAS testing and anti-EGFR therapy had an ICER of CA$73,759 per life-year gained (LYG) (95% CI 46,133–186,446). In scenario analysis, a reduction in cetuximab and panitumumab cost of at least 50% was required to make the policy change cost effective at a threshold of CA$50,000/LYG. Conclusion A policy of third-line anti-EGFR therapy informed by KRAS testing may be considered cost effective at thresholds above CA$70,000/LYG. Reduction in drug costs, through price discounts or potential future biosimilars, would make anti-EGFR therapy considerably more cost effective. By using real-world data for a large cohort with long follow-up we can assess the value of a policy of KRAS testing and anti-EGFR therapy achieved in practice.

Suggested Citation

  • Reka E. Pataky & Stirling Bryan & Mohsen Sadatsafavi & Stuart Peacock & Dean A. Regier, 2023. "Real-World Cost Effectiveness of a Policy of KRAS Testing to Inform Cetuximab or Panitumumab for Third-Line Therapy of Metastatic Colorectal Cancer in British Columbia, Canada," PharmacoEconomics - Open, Springer, vol. 7(6), pages 997-1006, November.
  • Handle: RePEc:spr:pharmo:v:7:y:2023:i:6:d:10.1007_s41669-023-00444-9
    DOI: 10.1007/s41669-023-00444-9
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    1. Mikyung Kelly Seo & John Cairns, 2018. "Do cancer biomarkers make targeted therapies cost-effective? A systematic review in metastatic colorectal cancer," PLOS ONE, Public Library of Science, vol. 13(9), pages 1-23, September.
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