Cost-effectiveness of cetuximab for the first-line treatment of squamous cell carcinoma of the head and neck (SCCHN) in Canada
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e17000 Background: Squamous cell carcinoma of the head and neck (SCCHN) is a disfiguring and potentially fatal condition. Cetuximab is a new therapeutic option which has been shown to improve locoregional control (LRC) and reduce mortality in the treatment of locally and regionally advanced disease. Objectives: To estimate the incremental cost-utility of cetuximab plus radiotherapy (CxRT) versus cisplatin plus radiotherapy (CsRT) among platinum eligible patients and versus RT alone in platinum ineligible patients in Canada. Methods: A lifetime transition model was developed with four health states: 1) acute treatment phase; 2) LRC; 3) disease progression and 4) death. Adverse events were accounted for in the first two states. Efficacy of treatment (LRC and overall survival) was obtained from the literature. Based on network meta-analyses, CsRT and CxRT were assumed to have equal efficacy. Resource use was obtained from published literature and clinical expert opinion. The perspective adopted was that of a provincial ministry of health or cancer agency. Utilities were obtained from a previous study of United Kingdom oncology nurses. Costs (2008 CDN$) and outcomes were discounted at 5% annually. Incremental cost-effectiveness ratios (ICERs) were reported with one-way and probabilistic sensitivity analyses performed to assess robustness of results. A priori sub-group analyses were carried out by baseline Karnofsky Performance Scores (KPS). Results: Among all patients (KPS 60–100), the ICERs comparing CxRT to RT were $19,740/QALY (95% CI: $11,122 to $695,295) among platinum ineligible patients and for CxRT vs. CsRT, $99,147/QALY (95% CI: $75,998 to $148,951) among platinum eligible patients. ICERs decreased with increasing KPS scores. At a willingness to pay of $50,000 among platinum-ineligible patients and $100,000 among platinum-eligible patients, the likelihood that CxRT is cost-effective is 90% and 45% respectively. Sensitivity analyses indicated that time horizon and assumptions about CsRT effectiveness had the largest impact on results. Conclusion: Cetuximab is an economically attractive option for SCCHN patients. [Table: see text]
