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Background: Pharmacoeconomic assessments are a part of the decision process not only during reimbursement setting, but in clinical practice as well. The presented cost-effectiveness analysis assesses panitumumab+mFOLFOX6 vs. bevacizumab+mFOLFOX6 in 1st line treatment of patients with wildtype RAS metastatic colorectal cancer (mCRC) in the Czech environment., Material and Methods: The adaptation of a Markov model considers the healthcare perspective; clinical data (efficacy, healthcare utilization and adverse events) are derived from a head-to-head comparison (PEAK study). Health states included in the model: progression free on treatment, progression (with/ without active treatment), resection of metastases, disease-free after successful resection and death. Actual reimbursement levels were used to estimate costs, published literature to estimate duration of 2nd line treatment. The analysis assumes a lifetime horizon; uncertainty was limited by performing one-way and probabilistic sensitivity analyses. Analysis outcomes are life-years gained (LYG) and quality-adjusted life-years (QALYs)., Results: Panitumumab+mFOLFOX6 is more effective and more costly in 1st line patients with wildtype RAS mCRC. Incremental costs per QALY are 837,270 CZK, per LYG 615,022 CZK; however, below the willingness-to-pay threshold applied in the Czech Republic., Conclusions: Panitumumab+mFOLFOX6 is cost-effective in 1st line treatment of patients with wildtype RAS mCRC compared to bevacizumab+mFOLFOX6 in the Czech setting.

Background: Bevacizumab, a humanized monoclonal IgG antibody against the vascular endothelial growth factor (VEGF), is reimbursed in combination with chemotherapy for the first and subsequent line treatment of patients with metastatic colorectal cancer (mCRC) in the Czech Republic. However, its high cost is a potentially limiting factor. We assessed the cost of bevacizumab in the treatment of mCRC in a comprehensive cancer center., Patients and Methods: A total of 218 patients were included in our analysis. Cost data (examination, medication, hospitalization) were collected since the initiation of bevacizumab treatment to any tumor response (RECIST criteria: complete response -  CR, partial response -  PR, stable disease -  SD, progressive disease -  PD) and/ or to death. Minimal followup for all patients was 28 months. Costs were valued in Czech crowns (CZK) and converted to EUR (1€ = 25.14 CZK)., Results: PD was recorded in 194 patients (89% of patients). The mean cost of treatment to PD (median TTP 9.1 months) was 1,002,076.30 CZK (39,859.84 EUR). The majority of costs to PD was made by medication -  917,048.60 CZK (36,477.67 EUR) per patient. The mean cost to response PR, CR or SD was 1,105,823.10 CZK (43,986.60 EUR) after median 9.8 months of treatment (recorded for 21 patients), medication formed 1,023,827.70 CZK (40,725.05 EUR). During the study, 170 patients (78%) died. The mean of the total costs since initiation of treatment to death (median OS 18.8 months) was 1,338,874.20 CZK (53,256.70 EUR) -  out of that, medication was 1,184,251.10 CZK (47,106.25 EUR) per patient., Conclusion: Targeted bio-logical therapy is the largest part of the costs of mCRC therapy. Cost of bevacizumab made up to 69% of costs to PD -  687,608.20 CZK ( 27,351.20 EUR ) per patient. The majority of the total cost was formed by targeted drug therapy (bevacizumab in 1st line therapy, cetuximab and panitumumab in 2nd and 3rd line therapy); 58% of total costs since initiation of treatment to death -  778,233.80 CZK (30,956 EUR) per patient.

A comparison of effectiveness of TNF antagonists adalimumab, infliximab and etanercept in the treatment of rheumatoid arthritis (RA) was made, which was derived from studies provided abroad based on routine clinical practice. The calculation of cost-effectiveness of each TNF antagonist for Czech Republic was made on the basis of Dutch DREAM registry of patients with RA (Kiewit et al, 2008). The prices of therapy of all three TNF antagonists are similar in the first year of treatment of patients with average weight, in the second year the price of infliximab is lower, but only in the case of patients where the doses do not reach 4 amp. of infliximab. Clinical effectiveness was evaluated in DAS28 and HAQ units. Cost-effectiveness of all TNF antagonists was similar, when 2 amp. of infliximab per dose phycician considered sufficient, but when patients were given higher doses of infliximab the trend to lower cost-effectiveness of infliximab compared to adalimumab and etanercept was observed.

Aim: To establish the probable prevalence and incidence of the exsudative (wet) age-related macular degeneration (AMD) in the Czech Republic and to compare possibilities and the expensiveness of the photodynamic therapy (PDT) and the treatment with substances blocking the vascular endothelial growth factor (anti-VEGF)., Methods: The calculation of the probable prevalence and incidence of the exsudative AMD in the Czech Republic (CR) was based on the world epidemiological studies. The expenses of the PDT and the anti-VEGF treatment for the patient and for the health insurances were based on the calculation of the Visudyne and anti-VEGF substances' prices in CR and worldwide., Results: If the European prevalence of the exsudative AMD in patients over 65 years of age is 2.3% and the prevalence of the risk soft drusen is 15 %, so in the CR out of 1.44 millions of inhabitants older than 65 years have approximately 33 000 the AMD, and the drusen at risk 216.000 inhabitants. If the 5-years incidence of the exsudative AMD in patients with drusen at risk is 3.4%, it may be expected the turn of the soft drusen into the exsudative AMD during the 5-years period in 7340 patients, or 1460 patients a year. The PDT is indicated in approx. 20% of exsudative AMD with the classical or predominantly classical choroid neovascularization (CNV), i.e. approx. 300 patients a year. If, at the average, 5.6 PDT sessions during 2 years are needed and the price is 42.500 CZK (Czech Crowns; 1 USD = approx. 20-22 CZK; 1 Euro = approx. 27-29 CZK) for one injection of Visudyne, so the average cost per patient is 238,000 CZK and the costs for all of them 71.4 millions of CZK. If the patient's participation is 7395 CZK per one dose of Visudyne, then the average patient's expense for the PDT during the 2 years period is 41 412 CZK. Anti-VEFG drugs as intravitreal injections are effective in all forms of exsudative AMD. Macugen (pegaptanib), already registered in the CR, should be applied in six-weeks intervals, during the two-years treatment period altogether up to 17 injections. At the price of 1000 USD for one application, the average treatment cost is 17,000 USD (= approx. 350, 000 CZK). If the one-year incidence of exsudative AMD is 1460 patients,their treatment with Macugen would cost 511 mil. CZK, and the treatment of 1140 patients with occult CNV not suitable for PDT would cost 410 mil. CZK. Lucentis (ranibizumab), which is about to be registered in the CR, is applied in one-months intervals, during two years altogether up to 20 injections. At the price 1200 USD a dose, the treatment costs for one patient would be 24,000 USD (approx. 500 000 CZK), treatment of all patients with exsudative AMD 730 mil. CZK, and costs for patients not suitable-for PDT treatment would be 585 mil. CZK. The intravitreal application of Avastin (bevacizumab) is "off label"; in the first three months is applied monthly, and later on, in 1-3 months interval, until the disappearance of exsudative changes. The maximum of applications is 10 injections during 2 years. At the price 3000 CZK for 1 injection, the treatment costs for one patient would be 30,000 CZK; treatment costs for all patients would be 43.8 mil. CZK, and for patients not suitable for PDT would be 34.8 mil. CZK., Conclusion: Nowadays, the PDT and anti-VEFG substances are the optimal treatment methods in exsudative AMD with CNV. PDT i s indicated in theclassical or predominantly classical choroid neovascularization (CNV), anti-VEFG drugs are effective in all forms of exsudative AMD. The high prices of Visudyne, Macugen, and Lucentis create barriers to their general use in all patients with exsudative AMD. Ten times lower price of "off label" applied Avastin supports its use in the competition with other anti-VEGF drugs. The combination of PDT with anti-VEGF drugs suggests the possible way, how to, not only, improve the effectiveness, but also to lower the number of applications, and by this means, also to reduce the economical expenses of the treatment dramatically.