Assessment of Clinically Meaningful Benefits and Incremental Costs of Adding Bevacizumab to Trifluridine/Tipiracil for Metastatic Colorectal Cancer: A Comparison With Other Combination Regimens
Author(s)
Epstein R1, Salimi T2, Khan N2, Johnson L3, Bornheimer R4, Weycker D4, Cann C5
1Epstein Health, LLC, Woodcliff Lake, NJ, USA, 2Taiho Oncology, Inc., Princeton, NJ, USA, 3Avalere Health, Washington, DC, USA, 4Avalere Health, Boston, MA, USA, 5Fox Chase Cancer Center, Philadelphia, PA, USA
Presentation Documents
OBJECTIVES: To review and compare clinically meaningful differences in terms of clinical benefits (Ellis et al. J Clin Oncol 2014; 32(12): 1277-80.) and incremental costs of adding a single agent to an existing regimen (including the addition of bevacizumab to trifluridine/tipiracil [FTD/TPI+BEV]) for advanced gastrointestinal cancers (aGIC) in the United States (US).
METHODS: Benchmarking of incremental benefits/costs was based on published Phase III trial data for qualifying regimens that included ≥1 branded agent, were approved for the treatment of aGIC in the US, and comprised combination therapies for which a single agent was added to an existing regimen. Clinical benefits were summarized based on overall survival (OS) and progression-free survival (PFS); costs (2024US$) included drugs and administration. Drug costs were based on projected utilization (median treatment duration) and price/unit; administration costs were based on published fee schedules. Adverse events (AEs) and treatment discontinuation were also summarized.
RESULTS: Eight regimens—FTD/TPI+BEV, paclitaxel+ramucirumab, fluorouracil+irinotecan+leucovorin (FOLFIRI)+ziv-aflibercept, FOLFIRI+ramucirumab, durvalumab+tremelimumab, durvalumab+ gemcitabine+cisplatin, and nivolumab+chemotherapy (two)—qualified for inclusion after targeted literature review. Addition of BEV to FTD/TPI yielded greatest improvements in clinical benefits versus single agents added to comparator regimens: increase in OS (median), 3.3 vs. 1.3 – 2.6 months; increase in PFS (median), 3.2 vs. -0.2 – 2.2 months. Differences in AEs and treatment discontinuation were generally favorable/comparable for FTD/TPI + BEV. Incremental cost of adding BEV to FTD/TPI was lower than addition of single agents to other regimens: absolute increment, $26,441 vs. $64,730 – $332,705; percentage increment, 32% vs. 150% – 6,080%.
CONCLUSIONS: Combination of BEV and FTD/TPI (vs. FTD/TPI) for the treatment of metastatic colorectal cancer yielded greater clinically meaningful benefits related to OS/PFS, and incremental costs of adding BEV to FTD/TPI were lower than addition of single agents to other regimens for aGIC that are currently used in US clinical practice.
Conference/Value in Health Info
Value in Health, Volume 27, Issue 12, S2 (December 2024)
Code
EE637
Topic
Clinical Outcomes, Economic Evaluation, Study Approaches
Topic Subcategory
Clinical Trials, Comparative Effectiveness or Efficacy, Cost-comparison, Effectiveness, Utility, Benefit Analysis, Literature Review & Synthesis
Disease
Drugs, Oncology