KRAS and BRAF Mutation Analysis in Metastatic Colorectal Cancer: A Cost-effectiveness Analysis from a Swiss Perspective
Autor: | Holger Moch, Matthias Schwenkglenks, Patricia R. Blank, Thomas D. Szucs |
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Rok vydání: | 2011 |
Předmět: |
Male
Proto-Oncogene Proteins B-raf Oncology Cancer Research medicine.medical_specialty Palliative care endocrine system diseases Colorectal cancer Cost-Benefit Analysis DNA Mutational Analysis Cetuximab Antibodies Monoclonal Humanized medicine.disease_cause Sensitivity and Specificity law.invention Proto-Oncogene Proteins p21(ras) Randomized controlled trial law Proto-Oncogene Proteins Internal medicine medicine Humans Epidermal growth factor receptor Neoplasm Metastasis Predictive testing neoplasms biology business.industry Palliative Care Antibodies Monoclonal Cancer Genes erbB-1 Middle Aged Prognosis medicine.disease Markov Chains digestive system diseases Mutation ras Proteins Cancer research biology.protein Female KRAS Colorectal Neoplasms business Switzerland medicine.drug |
Zdroj: | Clinical Cancer Research. 17:6338-6346 |
ISSN: | 1557-3265 1078-0432 |
Popis: | Purpose: Monoclonal antibodies against the epidermal growth factor receptor (EGFR), such as cetuximab, have led to significant clinical benefits for metastatic colorectal cancer (mCRC) patients but have also increased treatment costs considerably. Recent evidence associates KRAS and BRAF mutations with resistance to EGFR antibodies. We assessed the cost-effectiveness of predictive testing for KRAS and BRAF mutations, prior to cetuximab treatment of chemorefractory mCRC patients. Experimental Design: A life-long Markov simulation model was used to estimate direct medical costs (€) and clinical effectiveness [quality-adjusted life-years (QALY)] of the following strategies: KRAS testing, KRAS testing with subsequent BRAF testing of KRAS wild-types (KRAS/BRAF), cetuximab treatment without testing. Comparison was against no cetuximab treatment (reference strategy). In the testing strategies, cetuximab treatment was initiated if no mutations were detected. Best supportive care was given to all patients. Survival times/utilities were derived from published randomized clinical trials. Costs were assessed from the perspective of the Swiss health system. Results: Average remaining lifetime costs ranged from €3,983 (no cetuximab) to €38,662 (no testing). Cetuximab treatment guided by KRAS/BRAF achieved gains of 0.491 QALYs compared with the reference strategy. The KRAS testing strategy achieved an additional gain of 0.002 QALYs compared with KRAS/BRAF. KRAS/BRAF testing was the most cost-effective approach when compared with the reference strategy (incremental cost-effectiveness ratio: €62,653/QALY). Conclusion: New predictive tests for KRAS and BRAF status are currently being introduced in pathology. Despite substantial costs of predictive testing, it is economically favorable to identify patients with KRAS and BRAF wild-type status. Clin Cancer Res; 17(19); 6338–46. ©2011 AACR. |
Databáze: | OpenAIRE |
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