Cost Minimization Analysis of Bevacizumab Versus Cetuximab and Panitumumab in the Management of Colorectal Cancer from Patient Perspective in Egypt

Abstract

Objectives Colorectal cancer (CRC), the second most frequent type of cancer worldwide represents about 13.2% and 12.7% of all cancer cases in men and women respectively. At initial diagnosis, nearly 25% of patients present with metastatic CRC (mCRC), and 50% of patients with CRC will later develop metastases. The national comprehensive cancer network (NCCN) guidelines state that cetuximab, panitumumab or bevacizumab are equivalent choices as first line adjuvant therapy in addition to chemotherapy for RAS wild type (WT) mCRC. Similarly, all chemotherapy-antibody combinations are recommended for KRAS WT mCRC. The aim of this study was to perform a cost minimization analysis of bevacizumab versus cetuximab and panitumumab for the management of mCRC from patient perspective.

Methods Direct medical costs were reported in Egyptian pounds of the financial year 2016. The doses were calculated for an average patient weight and body surface area (BSA) of 65 kg and 1.7, respectively. No discounting was needed as costs were calculated for a treatment course of three months. One way sensitivity analysis was conducted and the variables (costs and patient weight or BSA) were varied with a range of ±25%.

Results Total costs for bevacizumab, cetuximab, panitumumab were EGP 48,750, EGP 186,675.30, and EGP 65,520, respectively. This study revealed that bevacizumab is the least expensive drug when compared to cetuximab and panitumumab in the management of mCRC. One way sensitivity analysis showed that the cost of drugs and the patient weight have the highest impact on the results; however the results are insensitive to change.

Conclusions Cetuximab, panitumumab or bevacizumab are equivalent choices as adjuvant therapies in both WT mCRC. Therefore, having the lowest cost, bevacizumab is the most preferred option when compared to cetuximab, panitumumab from the patient perspective for the management of mCRC.