Inpharma 1659 - 11 Oct 2008

Pharmacoeconomic news from ESMOStockholm, Sweden September 2008

The following highlights were presented at the 33rd at 5% annually, by extrapolating long-term survival andCongress of the European Society for Medical Oncology cost data from the 52-month follow-up of a pivotal(ESMO). multicentre trial.

The estimated mean life expectancy was 5.8 years forNew first-line option for mCRC in the UK imatinib-treated patients versus 3.1 years for untreatedFOLFOX* is the current standard of care for metastatic patients. An estimated 1.77 QALYs were gained at ancolorectal cancer (mCRC) in the UK. However, earlier expected incremental cost of $Can80 172** per patient;this year, the approved indication for bevacizumab was the corresponding ICER was $Can45 284 per QALY,extended to include its use in combination with which the researchers noted was "below the commonlyfluoropyrimidine-based chemotherapy. accepted threshold of $50,000/QALY". The results wereAccordingly, researchers from the UK and robust to model parameter changes.Switzerland have compared with cost effectiveness ofSunitinib rises for renal cancer in Swedenbevacizumab combined with capecitabine and

oxaliplatin (B Cape Ox) with FOLFOX for mCRC in the To assess cost effectiveness and transferability to theUK.1 They constructed a health state transition model to Swedish Health Service, researchers adapted a Markovestimate patient survival, using a parametric model based on international phase II/III trials indirectlyextrapolation of data from the phase III NO16966 trial. comparing sunitinib, sorafenib, temsirolimus and

Compared with FOLFOX, B Cape Ox was associated bevacizumab plus interferon-α in the first-line treatmentwith increases in overall survival (+2.4 months) and of metastatic renal cancer.4

QALYs (+0.138), but also increases in medical costs Sunitinib was associated with the highest projected(+£3568) per patient; the cost per QALY gained was progression-free and overall survival. Ten-year ICERs for£25 806, varying from £14 431 to £35 241 in the sunitinib versus sorafenib were SEK120 270† persensitivity analysis. progression-free life-year, SEK177 853 per life-year, and

The researchers concluded that, "for those patients SEK215 415 per QALY gained. Sunitinib dominatedcurrently eligible for FOLFOX, B Cape Ox represents a temsirolimus and bevacizumab/interferon-α as it wascost effective treatment option". both more effective and less costly than these

treatments.Where does panitumumab fit in mCRC? The researchers concluded that, "at SEK500,000/Another study has found that panitumumab is cost QALY, [sunitinib] had the highest probability of beingeffective for chemorefractory mCRC in patients with the most cost-effective per established thresholds forwild-type KRAS tumour status in The Netherlands.2societal willingness to pay for clinical benefit".Direct costs and outcomes associated with best* folinic acid, fluorouracil and oxaliplatinsupportive care (BSC) with or without panitumumab** Canadian dollarswere estimated using a decision analytic model and data† Swedish kronorfrom a phase III trial.

In the base-case analysis, the incremental cost- 1. Lewis G, et al. A cost utility analysis of bevacizumab (Avastin Rm),capecitabine (Xeloda Rm) and oxaliplatin compared to FOLFOX for theeffectiveness ratios (ICERs) for panitumumab plus BSCtreatment of metastatic carcinoma of the colon or rectum within the UK. 33rdversus BSC alone were €51 314 per life-year gained and Congress of the European Society for Medical Oncology : abstr. 384P, 12 Sep

€59 440 per QALY gained. The results were robust to 2008. Available from: URL: http://annonc.oxfordjournals.org.2. Graham CN, et al. Cost-effectiveness of panitumumab plus best supportive careassumptions around input parameters in univariate and

(BSC) compared with BSC alone in chemorefractory metastatic colorectalprobabilistic sensitivity analyses. "The ICER is within the cancer patients with wild-type KRAS tumor status in The Netherlands. 33rdCongress of the European Society for Medical Oncology : abstr. 387P, 12 Seprange of generally accepted willingness-to-pay2008. Available from: URL: http://annonc.oxfordjournals.org.thresholds", noted the study researchers.

3. El Ouagari K, et al. Cost-effectiveness of imatinib in the treatment of advancedgastrointestinal stromal tumors: Canadian perspective. 33rd Congress of theImatinib gets the GIST of it in CanadaEuropean Society for Medical Oncology : abstr. 722P, 12 Sep 2008. Available

The cost effectiveness of imatinib for the treatment of from: URL: http://annonc.oxfordjournals.org.4. Munir U, et al. Cost-effectiveness of sunitinib vs sorafenib, temsirolimus andmetastatic and/or unresectable gastrointestinal stromal

bevacizumab + interferon-alfa as first-line therapy for metastatic renal celltumours (GIST), which is already the standard of care, carcinoma - adaptation for the Swedish Health Service. 33rd Congress of theEuropean Society for Medical Oncology : abstr. 725P, 12 Sep 2008. Availablewas assessed from a Canadian third-party payerfrom: URL: http://annonc.oxfordjournals.org.perspective.3 Life-years, QALYs and costs were

801108172estimated over a 10-year time horizon, and discounted

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Inpharma 11 Oct 2008 No. 16591173-8324/10/1659-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved