Epigid Asco Gi 2009

EAL COST LINKED TO THE INTRODUCTION OF TARGETED THERAPIES

BEVACIZUMAB

CETUXIMAB

COMPARED TO CONVENTIONAL CHEMOTHERAPIES IN THE TREATMENT OF METASTATIC COLORECTAL CANCER F Grudé ([email protected])

 Access to new cancer drugs (bevacizumab, cetuximab):  Improvement of life  Very expensive treatment  End points :  Improving the knowledge of the costs of targeted therapies in reference to existing treatments (irinotecan, oxaliplatin) for patients with metastatic colorectal cancer  Develop tools to predict the evolution study with French Cancer Institute

 730 patients with metastatic colorectal cancer included in base of OMIT B PL (Observatory of the Drugs and Therapeutic Innovations in Bretagne and Pays de la Loire) Treatment

irinotecan

oxaliplatin

bevacizumab

cetuximab

Patient number

187

189

157

197

Age (mean) in years

67

66,3

61,7

62,7

Sexe (M/F) in %

    

62/38

56/44

59/41

66/34

2005/2006 38 public and private hospitals in west of France

V Roué, C Beauchamp, E Gamelin, G Robinet, J Metges, F Riou

 Components of cost  Related to chemotherapy  Hospitalizations 1day or more (H)  Drugs : targeted or conventional therapies and associated drugs  Travel Health  Other care : consultations, analysis of blood, programmable pump, nurse for pump, chemotherapy at home  Related to safety  Proven or probable hospitalizations related to complications of treatment  Growth factor  Current therapeutic line per drug  oxaliplatin and bevacizumab : first line (L1)  irinotecan : second line (L2)  cetuximab : third line (L3)

Part of the various components in the cost : € and % oxaliplatine

irinotecan

901€ 638€ 9% 6%

2 690€ 27%

556€ 6%

Protocols Protocols irinotecan : 180 mg/m² biweekly 5-FU : 400 mg/m² (bolus) and 2400 mg/m² (infusion 46h) folic acid : 400 mg/m² oxaliplatin : 85 mg/m² 5-FU : 400 mg/m² (bolus) and 2400 mg/m² (infusion 46h) folic acid : 400 mg/m²

1 055€ 846€ 3% 4% 629€ 2%

bevacizumab : 5 mg/ kg biweekly bevacizumab irinotecan : 180 mg/m² biweekly 5-FU : 400 mg/m² (bolus) and 2400 mg/m² (infusion 46h) cetuximab

cetuximab : 250 mg/m² biweekly after 400 mg/m2 irinotecan : 180 mg/m² biweekly

2 637€ 32%

 The cost about safety is 3% of the total cost for targeted therapies, and 10% for other treatments

Median and mean cost per patient irinotecan

oxaliplatin

bevacizumab

cetuximab

Median

8 825€

7 212€

25 907€

24 348€

Range

[ 770€ - 36 316€ ]

[ 325€ - 32 590€ ]

[ 1 758€ - 52 274€ ]

[ 2 243€ - 83 150€ ]

Mean

10 082€

8 360€

25 427€

28 273€

Standard Error

6 243€

4 970€

11 888€

16 868€

Duration break off

3.6 months

3.4 m

4.5 m

3.8 m

Number of doses

7

7

10

15

Components of the total cost per line treatment € 494

1 475€ 609€ 2% 188€ 5% 1%

1 973€ 8%

930

563

1303

9039

5 672€ 20% 362€ 1%

851

468 7338

5177 5177 0€

17191 17191

886

5000€

 other care

cetuximab

15000€ 10000€

 drugs

 health travel 3 665€ 14%

treatment

964

 H >24 hours

bevacizumab

 The hospital costs can vary by a factor of two depending on the

20000€

4 494€ 45%

 safety

 Drug costs are 3 higher than the hospital costs for targeted therapies

236

1 824€ 22%

 H <24 hours

tionnel therapies more than 8 000€

25000€

803€ 8%

Follow up : 1 year

oxaliplatin

914€ 11%

455€ 5%

Cost for one line of treatment

irinotecan

843€ 10%

1 686€ 20%

 Total cost for targeted therapies is more than 25 000€ and for conven-

3820

5506

L2

L3

L1

safety health travel other care drugs hospitalizations

Components are variable according to line. All treatments combined, the third line is an added cost of 8000€ compared to the 1st line (L1) and of 11 000€ compared to the 2nd line (L2). The drug is part 17 000€ for the 3rd line (L3), 9 000€ for the 1st line (L1) and 7 000€ for the 2nd line (L2). For patients receiving treatment with bevacizumab in the 1st line, and

17 259€ 68%

19 967€ 71%

Acknowledgments for Private and public hospitals in Bretagne and Pays de la Loire and for clinicians, pharmacists, Directors : CHU Brest, CH La Roche, Clinique Pasteur Brest, CLCC René Gauducheau Nantes, CLCC Paul Papin Angers, Clinique Océane Vannes, Centre Catherine Sienne Nantes, Clinique Armoricaine de Radiologie St Brieuc, Centre Jean Bernard Le Mans, CLCC Eugène Marquis Rennes, CH Laval, CH St Malo, Polyclinique Océan St Nazaire, CH Landerneau, Polyclinique Maine Laval, CHU Nantes, CH St Brieuc, CH Lannion, CH Le Mans, CH Morlaix, CH Lorient, CH Château Gontier, CH Quimper, CH Vannes, Polyclinique Parc Cholet, CH Douarnenez, Polyclinique Sud Quimper Brigitte Lemarquand scientific researcher

then cetuximab in the 2nd line, the mean cost of the two treatments is estimated around 50 000€. The overall cost of treatment is in 2006 of around 20 Millions € for Bretagne and Pays de la Loire

Overall survival

/

Relation cost/utility