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Published on: July 3, 2013
Cost-effectiveness analysis of screening for KRAS and BRAF mutations in metastatic colorectal cancer
Ajay S Behl1, Katrina A B Goddard, Thomas J Flottemesch
1HealthPartners Research Foundation, 8170 33rd Ave. S., Mail Stop 21111R, Bloomington, MN 55425, USA. Ajay.S.Behl@HealthPartners.com
Background:
In 2009, the American Society of Clinical Oncology recommended that patients with metastatic colorectal cancer (mCRC) who are candidates for anti-epidermal growth factor receptor (EGFR) therapy have their tumors tested for KRAS mutations because tumors with such mutations do not respond to anti-EGFR therapy. Limiting anti-EGFR therapy to those without KRAS mutations will reserve treatment for those likely to benefit while avoiding unnecessary costs and harm to those who would not. Similarly, tumors with BRAF genetic mutations may not respond to anti-EGFR therapy, though this is less clear. Economic analyses of mutation testing have not fully explored the roles of alternative therapies and resection of metastases.
Methods:
This paper is based on a decision analytic framework that forms the basis of a cost-effectiveness analysis of screening for KRAS and BRAF mutations in mCRC in the context of treatment with cetuximab. A cohort of 50 000 patients with mCRC is simulated 10 000 times, with attributes randomly assigned on the basis of distributions from randomized controlled trials.
Results:
Screening for both KRAS and BRAF mutations compared with the base strategy (of no anti-EGFR therapy) increases expected overall survival by 0.034 years at a cost of $22 033, yielding an incremental cost-effectiveness ratio of approximately $650 000 per additional year of life. Compared with anti-EGFR therapy without screening, adding KRAS testing saves approximately $7500 per patient; adding BRAF testing saves another $1023, with little reduction in expected survival.
Conclusions:
Screening for KRAS and BFAF mutation improves the cost-effectiveness of anti-EGFR therapy, but the incremental cost effectiveness ratio remains above the generally accepted threshold for acceptable cost effectiveness ratio of $100 000/quality adjusted life year.
Insights
Testing for KRAS and BRAF mutations in metastatic colorectal cancer (mCRC) improves anti-EGFR therapy cost-effectiveness. While KRAS and BRAF mutation screening enhances survival, the cost per quality-adjusted life year exceeds typical thresholds.
Area of Science:
- Oncology
- Genetics
- Health Economics
Background:
- ASCO recommends KRAS mutation testing for metastatic colorectal cancer (mCRC) patients considered for anti-EGFR therapy.
- KRAS mutations predict non-response to anti-EGFR therapy, guiding treatment decisions.
- BRAF mutations may also impact anti-EGFR therapy efficacy, though less definitively.
Purpose of the Study:
- To conduct a cost-effectiveness analysis of KRAS and BRAF mutation screening in mCRC.
- To evaluate the economic impact of mutation testing in the context of anti-EGFR therapy with cetuximab.
Main Methods:
- A decision analytic framework was employed for cost-effectiveness analysis.
- A simulated cohort of 50,000 mCRC patients was analyzed over 10,000 iterations.
- Patient attributes were randomly assigned based on randomized controlled trial data.
Main Results:
- Screening for KRAS and BRAF mutations increased expected survival by 0.034 years at a cost of $22,033 per patient.
- The incremental cost-effectiveness ratio (ICER) was approximately $650,000 per additional year of life.
- Compared to no screening, KRAS testing saved $7500 per patient; adding BRAF testing saved an additional $1023 with minimal survival reduction.
Conclusions:
- KRAS and BRAF mutation screening enhances the cost-effectiveness of anti-EGFR therapy for mCRC.
- The ICER for screening remains above the $100,000/quality-adjusted life year threshold.
- Mutation testing optimizes anti-EGFR therapy for patients likely to benefit, avoiding unnecessary costs and harm.
