Sequential biological therapies in metastatic colorectal cancer (mCRC): a cost comparison analysis for wild-type RAS mCRC patients in Brazil

Abstract

Objective: To compare the treatment costs of different sequences of regimens including monoclonal antibodies in metastatic colorectal cancer (CRCm) treatment for the Brazilian Supplementary Healthcare System. Methods:  Sixteen scenarios were analyzed, each one comparing a sequence of bevacizumab TML plus an anti-EGFR therapy in the third–line with another sequence without bevacizumab TML (non-Bev TML) in patients with CRCm wild-type RAS. The anti-EGFRs cetuximab and panitumumab were included. The monthly and total costs of the therapeutic sequences were compared per patient. Results: The sequences with Bev TML were cost-saving in 50% of all scenarios, and especially observed over regimens starting with cetuximab in the first-line treatment. Regarding scenarios which the non-Bev TML sequences were less costly, they all started with bevacizumab followed by an anti- -EGFR biologic drug. Conclusion: The Bev TML regimens were cost-saving compared to scenarios of non-Bev TML which started with cetuximab, and sequential use of bevacizumab beyond progression and the addition of an anti-EGFR biologic drug in the third-line for mCRC treatment. Considering the remaining scenarios in which Bev-TML was not cost-saving, those starting with Bev presented lower costs in total. Therefore, starting a treatment with bevacizumab seems to enable a more rational management of resource usage, as well as, to allow physicians to add a biologic drug in the third-line, potentially enhancing the long term management of wild-type RAS mCRC.