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Research Article
10 January 2025

Cost–effectiveness of cetuximab combined with radiotherapy versus radiotherapy alone in locally advanced head and neck cancer in Spain

Authors: Ruth Álvarez Cabellos, Jon Cacicedo, Susana Redondo Capafons, Heidi De los Santos Real, Miriam Brines Julián, Darío Rubio-Rodríguez [email protected], and Carlos Rubio-TerrésAuthor Info & Affiliations
Volume 14, Number 2
https://doi.org/10.57264/cer-2024-0116
PDFFormats

Abstract

Aim: To estimate the cost–effectiveness of cetuximab in combination with radiotherapy compared with radiotherapy alone, for the treatment of locally advanced head and neck cancer patients in Spain. Methods: A probabilistic Markov model (second-order Monte Carlo simulation) with a five-year time horizon and quarterly Markov cycles was performed from the perspective of the Spanish National Health System (NHS). Results: The additional cost and quality-adjusted life-year (QALY) gain per patient receiving radiotherapy in combination with cetuximab compared with radiotherapy alone was €4356 (95% CI: €4350–4362) and 0.2380 (95% CI: 0.2370–0.2391) QALY, respectively. The incremental cost per QALY gain was €18,303 (95% CI: €18,243–18,354) with a probability of cost–effectiveness of 65.4% for a willingness to pay of €30,000 per QALY gained. Conclusion: According to the results of this analysis, the addition of cetuximab to radiotherapy would be a cost-effective alternative to radiotherapy alone in the treatment of locally advanced head and neck cancer in Spain.

Plain language summary

What was the aim of this research?

To analyze the cost–effectiveness of the locally advanced head and neck cancer treatment with cetuximab combined with radiotherapy compared with radiotherapy alone, from the Spanish National Health System (NHS) perspective.

How was the research carried out?

A probabilistic Markov model (second-order Monte Carlo simulation) with a five-year time horizon and quarterly Markov cycles was performed. Data on disease control, recurrence and progression were obtained from the randomized clinical trials. Unit costs were obtained from Spanish official sources and from the existing literature. The use of health resources was estimated by a panel of Spanish clinical experts and from the literature. Utilities (quality-adjusted life years [QALY]) were obtained from a NICE report. Univariate sensitivity analyses (modifying one at a time all the variables of the model) were performed to confirm and provide robustness of the results.

What were the results?

The additional cost and QALY gain per patient receiving radiotherapy in combination with cetuximab compared with radiotherapy alone was €4356 and 0.2380 QALY, respectively. The incremental cost per QALY gain was €18,303 with a probability of cost–effectiveness of 65.4% for a willingness to pay of €30,000 per QALY gained. Most deterministic sensitivity analyses confirmed the cost–effectiveness of the combination of cetuximab and radiotherapy.

What do the results of the study mean?

Adding cetuximab to radiotherapy for the patient population diagnosed with locally advanced head and neck cancer could lead to additional clinical benefit for the patients at an acceptable cost for the healthcare system in Spain.

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