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Doublet Therapy Unlikely Cost-Effective for Metastatic BRAF Variant Colorectal Cancer

January 28, 2021

Doublet therapy for metastatic BRAF variant colorectal cancer is not cost-effective under current pricing, according to a recent evaluation published in JAMA Network Open (2021;4[1]:e2033441. doi:10.1001/jamanetworkopen.2020.33441).

“The BEACON trial showed that combination therapy with encorafenib and cetuximab was associated with prolonged overall survival compared with standard chemotherapy in patients with metastatic BRAF variant colorectal cancer,” wrote Kishan K Patel, BS, Department of Hematology/Oncology, Yale University School of Medicine (New Haven, CT), and colleagues.

“However, the cost-effectiveness of using these agents in this clinical setting is unknown,” they added.

This study aimed to compare the cost-effectiveness of doublet therapy (encorafenib plus cetuximab) with that of standard chemotherapy for patients with metastatic BRAF variant colorectal cancer.

A Markov model was constructed to examine the lifetime cost and utility of doublet therapy versus standard chemotherapy. Parametric survival modeling was used to evaluate the efficacy of each line of therapy from large clinical trials. Data was collected and analyzed between November 15, 2019, and July 14, 2020.

The primary end point was the incremental cost-effectiveness ratio (ICER).

Doublet therapy improved quality-adjusted life years (QALYs) by 0.15 compared with standard chemotherapy. However, doublet therapy had an incremental cost of $78,233, resulting in an ICER of $523,374 per QALY gained.

“This study found that doublet therapy for metastatic BRAF variant colorectal cancer was unlikely to be cost-effective under current pricing,” Patel and colleagues concluded.

“ Cost-effectiveness needs to be considered in clinical trial design, particularly when combining new therapies with non-cost-effective treatments that are coadministered without a fixed duration,” they added. —Marta Rybczynski

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