Conducting KRAS and BRAF testing in all metastatic colorectal cancer (mCRC) patients prior to treatment with anti–epidermal growth factor receptor (EGFR) therapies could save roughly $8,500 per patient or more than $103 million annually, according to a study published Nov. 28 in the Journal of the National Cancer Institute. The savings come, though, without any improvements in survival resulting from the testing strategy. KRAS and BRAF testing are used to identify those most likely to benefit from costly EGFR therapy, thereby avoiding unnecessary toxicity and cost for the roughly one-third of mCRC patients unlikely to respond to these drugs. The researchers developed a cost-effectiveness model in which a cohort of 50,000 mCRC patients was simulated 10,000 times with randomly assigned attributes (metastases site and real-world treatment patterns) based of distributions from previous randomized controlled trials. The four strategies tested included no anti-EGFR therapy, anti-EGFR therapy without screening, screening for only KRAS mutations before providing anti-EGFR therapy, and screening for KRAS and BRAF mutations before providing anti-EGFR therapy. The model followed each patient for 10 years. The researchers found that providing anti-EGFR therapy to all patients without any screening was the most costly strategy and only improved mean survival by approximately […]
Conducting KRAS and BRAF testing in all metastatic colorectal cancer (mCRC) patients prior to treatment with anti–epidermal growth factor receptor (EGFR) therapies could save roughly $8,500 per patient or more than $103 million annually, according to a study published Nov. 28 in the Journal of the National Cancer Institute. The savings come, though, without any improvements in survival resulting from the testing strategy.
KRAS and BRAF testing are used to identify those most likely to benefit from costly EGFR therapy, thereby avoiding unnecessary toxicity and cost for the roughly one-third of mCRC patients unlikely to respond to these drugs. The researchers developed a cost-effectiveness model in which a cohort of 50,000 mCRC patients was simulated 10,000 times with randomly assigned attributes (metastases site and real-world treatment patterns) based of distributions from previous randomized controlled trials.
The four strategies tested included no anti-EGFR therapy, anti-EGFR therapy without screening, screening for only KRAS mutations before providing anti-EGFR therapy, and screening for KRAS and BRAF mutations before providing anti-EGFR therapy. The model followed each patient for 10 years. The researchers found that providing anti-EGFR therapy to all patients without any screening was the most costly strategy and only improved mean survival by approximately one day. Adding just KRAS testing saved $7,493 per patient, and adding BRAF testing saved an additional $1,023, with little reduction in expected survival.
“Our results are less supportive of the use of anti-EGFR therapy than previous analyses, and they indicate lower cost savings from KRAS testing than previously reported,” concludes lead author Ajay S. Behl, Ph.D., a research associate at HealthPartners Research Foundation (Bloomington, Minn.). “Although we cannot confirm that anti-EGFR therapy is a cost-effective use of health care resources, we can affirm that KRAS testing is cost-saving. BRAF testing may offer additional savings.”
