Grading methodology for costs and values of anti-cancer drugs; application in metastatic colorectal cancer
Abstract
Background: The present study was prompted by the inability of patients to afford the costs and understand value issues of anticancer drugs. We postulated that society in the United States would be willing to pay 4-week costs (4wC) up to $5,000 and reject >$10,000.
Objectives: 1- Propose simplified methodology to grade costs, weigh values and apply in metastatic colorectal cancer (mCRC)
Methods: 4-week society costs (4wC) were graded A for up to $5,000, B $ >5,000 to $7,500, C $>7,500 to $10,000, D >$10,000. Values defined as C/life-year gain (LYG) were graded from A100,000 to D >300,000. Relative values (RV) were calculated with reference to 100,000 QALY. RV = 100,000/C/LYG for drugs with maintenance or improvement of quality of life (QoL).
Results: In 1st-line 4wC and grades of Bevacizumab (Bev) were $4,620/A. In KRAS wild type Paninutumab (Pan) was $8,233/C and Cetuximab (Cet) $9,775/C. Values and grades were Bev 141,549/B, Pan 269,444/B and Cet 351,900/D. The corresponding RV were 0.71, 0.49 and 0.28. In 2nd-line Ramucirumab (Ram) 4wC were $11,200/D, values 252,200/C and RV 0.20. In refractory disease Regorafenib (Reg) 4wC were $12,500/D, values 321,429/D and deductible $1,250 compared with TAS 102 $12,890/D, values 257,800/C and deductible $1,289. RV could not be ascertained for lack of immature and/or inconclusive QoL data.
Conclusions: Methodology to grade drug costs and values was feasible and user-friendly. In 1st-line mCRC Bev 4wC was affordable with grade A, higher than Pan and Cet. In later lines 4wC of Ram, TAS 102 and Reg were >$10,000 with D rating. Their values could improve with use at earlier lines of therapy.
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References
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DOI: http://dx.doi.org/10.18103/imr.v1i1.11
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