Healthcare costs associated with bevacizumab and cetuximab in second-line treatment of metastatic colorectal cancer

Abstract

Objective:

To compare the health care costs of patients with metastatic colorectal cancer (mCRC) who received second-line treatment with Avastin (bevacizumab) versus Erbitux (cetuximab), from the third-party payer’s perspective.

Methods:

Patients with mCRC were selected from the PharMetrics claims database if they received second-line therapy containing either bevacizumab (second-line bevacizumab cohort) or cetuximab (second-line cetuximab cohort). Six-month costs following second-line therapy start date and average monthly healthcare costs while on second-line therapy (in 2009 US$) were calculated and compared between the two groups.

Results:

A total of 2188 patients with mCRC who met the eligibility criteria were included in the analysis, including 1808 patients receiving bevacizumab and 380 patients receiving cetuximab in second-line treatment. Demographic and baseline characteristics were similar between the two groups. Patients’ mean age was 61 years and 56% were males. In second-line treatment, bevacizumab was commonly used with oxaliplatin (43.5%) and irinotecan-based regimens (40.4%), whereas cetuximab was commonly used with irinotecan-based regimens (68.2%). Bevacizumab patients had significantly lower total all-cause healthcare costs than cetuximab patients (adjusted difference: –$10,231, p = 0.020), and lower medical costs (–$10,796, p = 0.012) during the 6 months following second-line therapy initiation. Approximately half of the difference in total all-cause healthcare costs was attributable to the lower chemotherapy and targeted therapy costs (–$5635, p = 0.032) of bevacizumab patients than those of cetuximab patients. While on second-line therapy, bevacizumab patients also had lower average monthly all-cause healthcare costs than cetuximab patients.

Limitations:

Second-line treatment in the current study was defined based on changes in mCRC medications, not based on disease progression due to the limited clinical information available in claims.

Conclusion:

The use of bevacizumab in second-line therapy was associated with significantly lower healthcare costs in mCRC patients, compared to the use of cetuximab.

Keywords::

• Healthcare cost
• Bevacizumab
• Cetuximab
• Metastatic colorectal cancer
• Second-line treatment

Transparency

Declaration of funding

This study was carried out by Analysis Group, Inc. Funding for this study was provided by Genentech Inc. H.Y., A.P.Y., Y.Y., E.Y., and E.Q.W. contributed to the conception and design of this study; H.Y. and A.P.Y. performed data analysis; H.Y., A.P.Y., Y.Y., E.Y., and E.Q.W. provided data interpretation; and H.Y., A.P.Y., Y.Y., E.Y., and E.Q.W. wrote and approved the manuscript.

Declaration of financial/other relationships

A.P.Y., H.Y., and E.Q.W. are employees of Analysis Group Inc., which has received consulting fees from Genentech for research related to this manuscript. Y.Y. and E.Y. are employees of Genentech.