Cost-effectiveness of targeted therapy with cetuximab in patients with K-ras wild-type colorectal cancer presenting with initially unresectable metastases limited to the liver in a German setting.

摘要: Background: In patients with metastases limited to the liver (liver-limited disease LLD) effective therapies such as monoclonal antibodies combined chemotherapy may facilitate metastasis resection and improve long-term survival. Objective: This study assessed cost-effectiveness of bevacizumab cetuximab in treatment colorectal cancer presenting initially unresectable Kirsten rat sarcoma viral oncogene homolog (K-ras) wild type, from perspective German statutory health insurance. Methods: The health-economic modeling approach presented here made indirect comparisons between available data on outcomes using evidence synthesis techniques, extrapolating follow-up duration identified clinical trials a longer time horizon up 10 years inferring costs based modeled patient pathways. Expert opinion Delphi panel methods were used for some assumptions, when was missing. Probabilistic sensitivity analyses different scenario applied test uncertainty around input parameters assumptions. Results: For metastatic LLD population K-ras wild-type genotype, mean overall survival estimates 37.7 months first-line plus FOLFIRI (irinotecan, leucovorin, fluorouracil) 30.4 FOLFOX (oxaliplatin, fluorouracil). Corresponding discounted 2.88 life-years versus 2.38 FOLFOX, an average gain 0.50 life-years. incremental ratio 15,020 (year 2010) per life-year gained base case (with 95% CI probabilistic analysis 3806 24,660). Results robust well analysis. Conclusions: First-line offers cost-effective option genotype Germany. testing should be performed all cases ensure access this option. (Clin Ther. 2011;33:482-497) (C) 2011 Elsevier HS Journals, Inc. All rights reserved.