A prospective economic analysis of cost-effectiveness of cetuximab for metastatic colorectal cancer patients from the NCIC CTG and AGITG CO.17 trial
Bibliographic record
Abstract
6528 Background: CO.17 study is the first intergroup (Canadian/Australian) trial, that prospectively collected resource utilization and utility data for cetuximab (N=283) vs. best supportive care alone (BSC; N=274) in advanced colorectal cancer patients. A cost-effectiveness analysis was conducted based on the improved survival, higher cost of cetuximab and variable costs across countries from the perspective of the Canadian health care system. Methods: The mean difference in trial survival times between cetuximab and BSC was calculated. Direct medical resource utilization data was collected during the trial from the time of randomization until death or study closure. Trial resources included medications physician visits, toxicity management, institutionalization, emergency department visits and hospitalizations. Mean overall incremental cost (2007 $CAN-provincial sources) was determined. Drug acquisition costs (DAC) for cetuximab, based on several countries, were used to determine the incremental cost effectiveness ratio (ICER) in dollars per life-year gained (LYG). Sensitivity analyses for cetuximab DACs were conducted. Bootstrapping (1,000 iterations) provided 95%CI. Results: Mean incremental trial survival was 0.12 years. Preliminary results showed variability in the ICER, where DAC was the cost driver. At the lowest DAC ($2.94/mg), overall incremental costs were $19,361 for cetuximab compared to BSC, with incremental values of $1,086 for toxicity management, $1,016 for hospitalization, and $410 plus $81 for oncologist and family physician visits respectively. The ICER for cetuximab was $183,287/LYG (95%CI: $114,139-$581,027) using a $2.94/mg DAC (Switzerland), $198,467/LYG ($123,509-$558,270; $3.24/mg-Canadian suggested) and $375,047/LYG ($237,139- $1,233,111; $6.73/mg US). Sensitivity analyses produced an ICER of $50,000/LYG at $0.28/mg; $100,000/LYG at $1.30/mg and $200,000/LYG at $3.27/mg. Cost per quality adjusted life year will also be determined. Conclusions: Cetuximab showed high and variable ICERs dependent on a range of DACs in CO.17 advanced colorectal cancer patients. Utility will impact the incremental value. No significant financial relationships to disclose.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.022 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.005 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".