Purpose: Cetuximab is a monoclonal antibody which acts by binding to EGFR (epidermal growth factor receptor) and reducing the EGFR expression on the cell surface. A recent phase III trial (Vermorken et al., NEJM 359; 11) has shown that cetuximab plus platinum-fluorouracil chemotherapy improved overall survival when given as first-line treatment in patients with recurrent or metastatic squamous-cell carcinoma of the head and neck. We conducted a cost effectiveness analysis of cetuximab plus platinum-fluorouracil chemotherapy versus platinum-fluorouracil chemotherapy alone.
Methods: We developed a Markov model of cancer progression. The transition probabilities were derived from the phase III clinical trial data. Health outcomes were measured in quality-adjusted life years (QALYs). Costs, unadjusted for geographic location, were estimated using information from Ontario, Canada. Only direct costs, including the cost of drug therapy and administration costs, were considered in this analysis. Future costs and health benefits were discounted at 5%.
Results: In the base case, the incremental cost-effectiveness ratio (ICER) for cetuximab plus platinum-based chemotherapy is C$234,013 per quality-adjusted life-year (QALY), compared to platinum-based chemotherapy alone. In probabilistic sensitivity analysis ICER values ranged from $91,912/QALY to $2,851,501. In one-way sensitivity analysis the ICER was most sensitive to the difference in utility score between cetuximab plus platinum-fluorouracil chemotherapy versus platinum-fluorouracil chemotherapy.
Conclusions: The base case ICER is significantly above C$100,000. Although there are a number of new cancer treatments that have comparable ICERs, this value is very high compared to the values normally accepted by public payers in Canada. Future trials measuring EGFR status may help in targeting patients who are most likely to benefit from cetuximab and in making this treatment cost effective for a subset of patients.
Candidate for the Lee B. Lusted Student Prize Competition