Maintenance Therapies Exceed Willingness-To-Pay Thresholds in Metastatic Colorectal Cancer

Costs associated with maintenance bevacizumab (Avastin, Genentech/Roche) and capecitabine for patients with metastatic colorectal cancer exceeded willingness-to-pay thresholds and were not deemed cost-effective, according to an analysis of randomized trial data.

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The CAIRO 3 trial found that the addition of maintenance bevacizumab and capecitabine to observation after treatment for unresectable metastatic colorectal cancer improved overall survival in this patient population. Despite these data, Kiran Turaga, MD, MPH, associate professor of surgery and director of the Surgical GI Cancer Program at The University of Chicago Medicine (Chicago, IL), and colleagues surmised that the cost of maintenance therapy would exceed willingness-to-pay thresholds.

The researchers used data from the CAIRO 3 trial to generate incremental cost-effectiveness ratios (ICERs) for maintenance strategies in the patient population. They found that cost of 10 maintenance cycles was $108 848, correlating with a gain in quality-adjusted life months (QALMs) of 14.93. In contrast, patients in the observation arm achieved a QALM gain of 13.67 at no additional cost, producing an ICER of $1 036 648 per quality-adjusted life year.

The use of observation alone was shown to be more cost-efficient, unless the cost of maintenance therapy fell below a threshold of $6 250 per cycle. “Reducing drug pricing is the only way to financially support the argument for this treatment strategy,” Dr Turaga and colleagues wrote.