COST-EFFECTIVENESS ANALYSIS OF CETUXIMAB FOR THE TREATMENT OF HEAD AND NECK CANCERS IN INDIA...
Author(s)
Jyoti Dixit, Sr., PhD, MPH1, Nidhi Gupta, MD, DNB2, Gaurav Jyani, PhD, MPH1, Shankar Prinja, MD, MSc, DNB1.
1Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India, 2Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, Chandigarh, India.
1Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India, 2Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, Chandigarh, India.
OBJECTIVES: The study aimed to ascertain the costs and health benefits associated with (i) the use of Radiotherapy (RT) along with Cetuximab (CTX) over RT alone for Locally advanced head and neck cancer (LAHNC) patients who are ineligible for cisplatin-based chemoradiotherapy and (ii) Chemotherapy (CT) +CTX over CT alone for Recurrent and metastatic head and neck cancer (R/MHNC) patients from the perspective of Indian healthcare system.
METHODS: A Markov model was constructed to assess the lifetime costs and health outcomes using cetuximab in combination with radiotherapy (RT+CTX) for treatment of cisplatin-ineligible LAHNC (Analysis I), and cetuximab in combination with platinum-based chemotherapy (CT+CTX) for treatment of R/MHNC patients in India (Analysis II). Using an abridged societal perspective lifetime costs and quality adjusted life years (QALYs) were evaluated, discounting future costs and consequences at 3% annually. For both the analyses, costs of original as well as biosimilar cetuximab were evaluated. The cost-effectiveness was assessed in terms of incremental cost effectiveness ratio (ICER) which was compared against a threshold of 1-time per capita gross domestic product (GDP) for India in 2024-25 (₹ 2,47,045; US$ 2,697).
RESULTS: Adding biosimilar cetuximab to radiotherapy for cisplatin ineligible LAHNC patients results in lifetime gain of 2.80 (95% CI: 2.24-3.3) QALYs. Similarly, biosimilar cetuximab when added to platinum-based chemotherapy for R/MHNC leads to 0.83 (95% CI: 0.65-1.02) QALYs. The incremental cost per QALY gained was found to be ₹ 412,949 with use of RT+CTX and ₹ 17,286,670 with use of CT+CTX. At the currently recommended willingness to pay (WTP) threshold, treatment with cetuximab is not a cost-effective treatment option for patients with LAHNC and R/MHNC patients respectively in India. A 50% reduction in the price of biosimilar.
CONCLUSIONS: Strategic purchasing of biosimilar cetuximab at reduced price can provide good value for money for treatment of patients with LAHNC.
METHODS: A Markov model was constructed to assess the lifetime costs and health outcomes using cetuximab in combination with radiotherapy (RT+CTX) for treatment of cisplatin-ineligible LAHNC (Analysis I), and cetuximab in combination with platinum-based chemotherapy (CT+CTX) for treatment of R/MHNC patients in India (Analysis II). Using an abridged societal perspective lifetime costs and quality adjusted life years (QALYs) were evaluated, discounting future costs and consequences at 3% annually. For both the analyses, costs of original as well as biosimilar cetuximab were evaluated. The cost-effectiveness was assessed in terms of incremental cost effectiveness ratio (ICER) which was compared against a threshold of 1-time per capita gross domestic product (GDP) for India in 2024-25 (₹ 2,47,045; US$ 2,697).
RESULTS: Adding biosimilar cetuximab to radiotherapy for cisplatin ineligible LAHNC patients results in lifetime gain of 2.80 (95% CI: 2.24-3.3) QALYs. Similarly, biosimilar cetuximab when added to platinum-based chemotherapy for R/MHNC leads to 0.83 (95% CI: 0.65-1.02) QALYs. The incremental cost per QALY gained was found to be ₹ 412,949 with use of RT+CTX and ₹ 17,286,670 with use of CT+CTX. At the currently recommended willingness to pay (WTP) threshold, treatment with cetuximab is not a cost-effective treatment option for patients with LAHNC and R/MHNC patients respectively in India. A 50% reduction in the price of biosimilar.
CONCLUSIONS: Strategic purchasing of biosimilar cetuximab at reduced price can provide good value for money for treatment of patients with LAHNC.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
EE54
Topic
Economic Evaluation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology, STA: Multiple/Other Specialized Treatments