Cost-effectiveness of capecitabine and bevacizumab maintenance treatment after first-line induction treatment in metastatic colorectal cancer

M. D. Franken; E. M. van Rooijen; A. M. May; H. Koffijberg; H. van Tinteren; L. Mol; A. J. ten Tije; G. J. Creemers; A. M. T. van der Velden; B. C. Tanis; C. A. Uyl-de Groot; C. J. A. Punt; M. Koopman; M. G. H. van Oijen

doi:10.1016/j.ejca.2017.01.019

Cost-effectiveness of capecitabine and bevacizumab maintenance treatment after first-line induction treatment in metastatic colorectal cancer

M. D. Franken
, E. M. van Rooijen
, A. M. May
, H. Koffijberg
, H. van Tinteren
, L. Mol
, A. J. ten Tije
, G. J. Creemers
, A. M. T. van der Velden
, B. C. Tanis
, C. A. Uyl-de Groot
, C. J. A. Punt
, M. Koopman
, M. G. H. van Oijen

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Aim

Capecitabine and bevacizumab (CAP-B) maintenance therapy has shown to be more effective compared with observation in metastatic colorectal cancer patients achieving stable disease or better after six cycles of first-line capecitabine, oxaliplatin, bevacizumab treatment in terms of progression-free survival. We evaluated the cost-effectiveness of CAP-B maintenance treatment.

Methods

Decision analysis with Markov modelling to evaluate the cost-effectiveness of CAP-B maintenance compared with observation was performed based on CAIRO3 study results (n = 558). An additional analysis was performed in patients with complete or partial response. The primary outcomes were the incremental cost-effectiveness ratio (ICER) defined as the additional cost per life year (LY) and quality-adjusted life years (QALY) gained, calculated from EQ-5D questionnaires and literature and LYs gained. Univariable sensitivity analysis was performed to assess the influence of input parameters on the ICER, and a probabilistic sensitivity analysis represents uncertainty in model parameters.

Results

CAP-B maintenance compared with observation resulted in 0.21 QALYs (0.18LYs) gained at a mean cost increase of €36,845, yielding an ICER of €175,452 per QALY (€204,694 per LY). Varying the difference in health-related quality of life between CAP-B maintenance and observation influenced the ICER most. For patients achieving complete or partial response on capecitabine, oxaliplatin, bevacizumab induction treatment, an ICER of €149,300 per QALY was calculated.

Conclusion

CAP-B maintenance results in improved health outcomes measured in QALYs and LYs compared with observation, but also in a relevant increase in costs. Despite the fact that there is no consensus on cost-effectiveness thresholds in cancer treatment, CAP-B maintenance may not be considered cost-effective.

Original language	English
Pages (from-to)	204-212
Number of pages	9
Journal	European Journal of Cancer
Volume	75
DOIs	https://doi.org/10.1016/j.ejca.2017.01.019
Publication status	Published - Apr 2017

Keywords

Bevacizumab
Cancer
Capecitabine
Colorectal
Cost-effectiveness

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10.1016/j.ejca.2017.01.019

capecitabineFinal published version, 492 KBLicence: Taverne

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Franken, M. D., van Rooijen, E. M., May, A. M., Koffijberg, H., van Tinteren, H., Mol, L., ten Tije, A. J., Creemers, G. J., van der Velden, A. M. T., Tanis, B. C., Groot, C. A. U., Punt, C. J. A., Koopman, M., & van Oijen, M. G. H. (2017). Cost-effectiveness of capecitabine and bevacizumab maintenance treatment after first-line induction treatment in metastatic colorectal cancer. European Journal of Cancer, 75, 204-212. https://doi.org/10.1016/j.ejca.2017.01.019

@article{fdf64e6c0eb0496ab32571510c1d9bc7,

title = "Cost-effectiveness of capecitabine and bevacizumab maintenance treatment after first-line induction treatment in metastatic colorectal cancer",

abstract = "Aim Capecitabine and bevacizumab (CAP-B) maintenance therapy has shown to be more effective compared with observation in metastatic colorectal cancer patients achieving stable disease or better after six cycles of first-line capecitabine, oxaliplatin, bevacizumab treatment in terms of progression-free survival. We evaluated the cost-effectiveness of CAP-B maintenance treatment. Methods Decision analysis with Markov modelling to evaluate the cost-effectiveness of CAP-B maintenance compared with observation was performed based on CAIRO3 study results (n = 558). An additional analysis was performed in patients with complete or partial response. The primary outcomes were the incremental cost-effectiveness ratio (ICER) defined as the additional cost per life year (LY) and quality-adjusted life years (QALY) gained, calculated from EQ-5D questionnaires and literature and LYs gained. Univariable sensitivity analysis was performed to assess the influence of input parameters on the ICER, and a probabilistic sensitivity analysis represents uncertainty in model parameters. Results CAP-B maintenance compared with observation resulted in 0.21 QALYs (0.18LYs) gained at a mean cost increase of €36,845, yielding an ICER of €175,452 per QALY (€204,694 per LY). Varying the difference in health-related quality of life between CAP-B maintenance and observation influenced the ICER most. For patients achieving complete or partial response on capecitabine, oxaliplatin, bevacizumab induction treatment, an ICER of €149,300 per QALY was calculated. Conclusion CAP-B maintenance results in improved health outcomes measured in QALYs and LYs compared with observation, but also in a relevant increase in costs. Despite the fact that there is no consensus on cost-effectiveness thresholds in cancer treatment, CAP-B maintenance may not be considered cost-effective.",

keywords = "Bevacizumab, Cancer, Capecitabine, Colorectal, Cost-effectiveness",

author = "Franken, \{M. D.\} and \{van Rooijen\}, \{E. M.\} and May, \{A. M.\} and H. Koffijberg and \{van Tinteren\}, H. and L. Mol and \{ten Tije\}, \{A. J.\} and Creemers, \{G. J.\} and \{van der Velden\}, \{A. M. T.\} and Tanis, \{B. C.\} and Groot, \{C. A. Uyl-de\} and Punt, \{C. J. A.\} and M. Koopman and \{van Oijen\}, \{M. G. H.\}",

note = "Publisher Copyright: {\textcopyright} 2017 Elsevier Ltd",

year = "2017",

month = apr,

doi = "10.1016/j.ejca.2017.01.019",

language = "English",

volume = "75",

pages = "204--212",

journal = "European Journal of Cancer",

issn = "0959-8049",

publisher = "Elsevier Limited",

}

Franken, MD, van Rooijen, EM, May, AM, Koffijberg, H, van Tinteren, H, Mol, L, ten Tije, AJ, Creemers, GJ, van der Velden, AMT, Tanis, BC, Groot, CAU, Punt, CJA, Koopman, M & van Oijen, MGH 2017, 'Cost-effectiveness of capecitabine and bevacizumab maintenance treatment after first-line induction treatment in metastatic colorectal cancer', European Journal of Cancer, vol. 75, pp. 204-212. https://doi.org/10.1016/j.ejca.2017.01.019

TY - JOUR

T1 - Cost-effectiveness of capecitabine and bevacizumab maintenance treatment after first-line induction treatment in metastatic colorectal cancer

AU - Franken, M. D.

AU - van Rooijen, E. M.

AU - May, A. M.

AU - Koffijberg, H.

AU - van Tinteren, H.

AU - Mol, L.

AU - ten Tije, A. J.

AU - Creemers, G. J.

AU - van der Velden, A. M. T.

AU - Tanis, B. C.

AU - Groot, C. A. Uyl-de

AU - Punt, C. J. A.

AU - Koopman, M.

AU - van Oijen, M. G. H.

PY - 2017/4

Y1 - 2017/4

N2 - Aim Capecitabine and bevacizumab (CAP-B) maintenance therapy has shown to be more effective compared with observation in metastatic colorectal cancer patients achieving stable disease or better after six cycles of first-line capecitabine, oxaliplatin, bevacizumab treatment in terms of progression-free survival. We evaluated the cost-effectiveness of CAP-B maintenance treatment. Methods Decision analysis with Markov modelling to evaluate the cost-effectiveness of CAP-B maintenance compared with observation was performed based on CAIRO3 study results (n = 558). An additional analysis was performed in patients with complete or partial response. The primary outcomes were the incremental cost-effectiveness ratio (ICER) defined as the additional cost per life year (LY) and quality-adjusted life years (QALY) gained, calculated from EQ-5D questionnaires and literature and LYs gained. Univariable sensitivity analysis was performed to assess the influence of input parameters on the ICER, and a probabilistic sensitivity analysis represents uncertainty in model parameters. Results CAP-B maintenance compared with observation resulted in 0.21 QALYs (0.18LYs) gained at a mean cost increase of €36,845, yielding an ICER of €175,452 per QALY (€204,694 per LY). Varying the difference in health-related quality of life between CAP-B maintenance and observation influenced the ICER most. For patients achieving complete or partial response on capecitabine, oxaliplatin, bevacizumab induction treatment, an ICER of €149,300 per QALY was calculated. Conclusion CAP-B maintenance results in improved health outcomes measured in QALYs and LYs compared with observation, but also in a relevant increase in costs. Despite the fact that there is no consensus on cost-effectiveness thresholds in cancer treatment, CAP-B maintenance may not be considered cost-effective.

AB - Aim Capecitabine and bevacizumab (CAP-B) maintenance therapy has shown to be more effective compared with observation in metastatic colorectal cancer patients achieving stable disease or better after six cycles of first-line capecitabine, oxaliplatin, bevacizumab treatment in terms of progression-free survival. We evaluated the cost-effectiveness of CAP-B maintenance treatment. Methods Decision analysis with Markov modelling to evaluate the cost-effectiveness of CAP-B maintenance compared with observation was performed based on CAIRO3 study results (n = 558). An additional analysis was performed in patients with complete or partial response. The primary outcomes were the incremental cost-effectiveness ratio (ICER) defined as the additional cost per life year (LY) and quality-adjusted life years (QALY) gained, calculated from EQ-5D questionnaires and literature and LYs gained. Univariable sensitivity analysis was performed to assess the influence of input parameters on the ICER, and a probabilistic sensitivity analysis represents uncertainty in model parameters. Results CAP-B maintenance compared with observation resulted in 0.21 QALYs (0.18LYs) gained at a mean cost increase of €36,845, yielding an ICER of €175,452 per QALY (€204,694 per LY). Varying the difference in health-related quality of life between CAP-B maintenance and observation influenced the ICER most. For patients achieving complete or partial response on capecitabine, oxaliplatin, bevacizumab induction treatment, an ICER of €149,300 per QALY was calculated. Conclusion CAP-B maintenance results in improved health outcomes measured in QALYs and LYs compared with observation, but also in a relevant increase in costs. Despite the fact that there is no consensus on cost-effectiveness thresholds in cancer treatment, CAP-B maintenance may not be considered cost-effective.

KW - Bevacizumab

KW - Cancer

KW - Capecitabine

KW - Colorectal

KW - Cost-effectiveness

UR - https://www.scopus.com/pages/publications/85013672340

U2 - 10.1016/j.ejca.2017.01.019

DO - 10.1016/j.ejca.2017.01.019

M3 - Article

C2 - 28237866

SN - 0959-8049

VL - 75

SP - 204

EP - 212

JO - European Journal of Cancer

JF - European Journal of Cancer

ER -

Cost-effectiveness of capecitabine and bevacizumab maintenance treatment after first-line induction treatment in metastatic colorectal cancer

Abstract

Keywords

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