The cost-effectiveness and cost-utility analysis of adding Cetuximab to Platinum Based Chemotherapy for Treatment of Metastatic Head and Neck Cancer.

Introduction: This study was conducted to assess the cost-effectiveness of adding cetuximab to cisplatin and fluorouracil in the treatment of patients with recurrent head and neck carcinoma from the perspective of the Iranian public healthcare system. Methods: A systematicreview and consultation with clinicians on cetuximab add on therapy use, in HNSCC and its effect on transition probabilities, source of cost and quality of life has performed. Then, a time-varying probabilities for the transition of Markov model was developed by the implementation of Iranspecific features. The model begins with a decision to treat with cetuximab plus platinum-based chemotherapy (11 states) or platinum-based chemotherapy alone (3 states). Uncertain parameters are assigned probability distributions and analyses performed by Monte Carlo simulation. Future costs and health benefits were respectively discounted at 5% and 3%. Result: In the base case, cetuximab add‐on therapy led to an increase of 0.06 QALY and 519,651,755 Rial per person, resulting in an incremental cost-effectiveness ratio (ICER) of 828,128,259.91966 Rial per QALYgained. The cost-effectiveness ratio was most sensitive to the cost per mg of maintenance dose of cetuximab. Conclusion: Due to the Iranian Health Organization-recommended cost-effectiveness threshold Adding cetuximab to cisplatin and fluorouracil despite 0.06 QALY gain, cannot beconsidered cost-effective in patients with head and neck cancer in Iran.

کلیدواژه ها:

Economic evaluation ، cetuximab ، head and neck carcinoma ، time-varying probabilities ، quality of life