Metastatic Colorectal Cancer: A Systematic Review of the Value of Current Therapies

• Type of Material: Article
• Authors: Daniel Goldstein, Emory University; Simon B. Zeichner, Emory University; Catherine M. Bartnik, Emory University; Eli Neustadter, Emory University; Christopher Flowers, Emory University
• Language: English
• Date: 2016-03-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016 Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.clcc.2015.10.002
• Title of Journal or Parent Work: Clinical Colorectal Cancer
• ISSN: 1533-0028
• Volume: 15
• Issue: 1
• Start Page: 1
• End Page: 6
• Grant/Funding Information: Funding: NIH T32 Grant - T32CA160040-02
• Keywords: Incremental cost effectiveness ratio; LIVER METASTASES; 2-STAGE HEPATECTOMY; COST-EFFECTIVENESS ANALYSIS; BOLUS FLUOROURACIL; Value; Chemotherapy; Life Sciences & Biomedicine; Cost-effectiveness; Colorectal cancer; PHASE-III; RANDOMIZED-TRIAL; UNITED-STATES; FLUOROURACIL DOSE ADJUSTMENT; GLUCURONOSYLTRANSFERASE 1A1; Science & Technology; 1ST-LINE THERAPY; Oncology
• Research Categories: Health Sciences, Oncology; Health Sciences, Rehabilitation and Therapy

Abstract

To evaluate, from a US payer perspective, the cost-effectiveness of treatment strategies for metastatic colorectal cancer (mCRC), we performed a systematic review of published cost-effectiveness analyses. We identified 14 papers that fulfilled our search criteria and revealed varying levels of value among current treatment strategies. Older agents such as 5-fluorouracil, irinotecan, and oxaliplatin provide high-value treatments. More modern agents targeting the EGFR or VEGF pathways, such as bevacizumab, cetuximab, and panitumumab, do not appear to be cost-effective treatments at their current costs. The analytical methods used within the papers varied widely, and this variation likely plays a significant role in the heterogeneity in incremental cost-effectiveness ratios. The cost-effectiveness of current treatment strategies for mCRC is highly variable. Drugs recently approved by the US Food and Drug Administration for mCRC are not cost-effective, and this is primarily driven by high drug costs.