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**Background:** In order to facilitate sound economic evaluations of novel treatments, health-economic models of polycythemia vera (PV) must combine effects on surrogate endpoints in trials with disease progression (DP) and mortality in long-term cohort data. **Objective:** We validate an economic model for PV that uses Janus Kinase 2 (JAK2) burden as a surrogate endpoint to predict DP (thrombosis, myelofibrosis, and acute leukemia) and overall survival (OS) based on progression-specific mortality. **Methods:** Long-term observational studies that include information about baseline JAK2 burden were identified via PubMed searches and used to validate the model. Kaplan-Meier (KM) OS curves were extracted using a digitizing software. External validity of the model was analyzed by visually comparing OS curves of the model with the KM curves of the included studies, as well as calculating differences in mean OS estimated as area under the curve (AUC). **Results:** The model’s predictions of cumulative DP were somewhat lower than the published studies. Over 20 years’ time, our base case model predicted a mean OS for a PV patient (15.0–16.5 years), which was in line with the published studies (15.8–17.5 years). Modeled mean OS was almost two years longer (1.6–1.9 years) for patients with JAK2

Purpose In this analysis, we compared costs and explored the cost-effectiveness of subsequent-line treatment with cetuximab or panitumumab in patients with wild-type KRAS (exon 2) metastatic colorectal cancer (mCRC) after previous chemotherapy treatment failure. Data were used from ASPECCT (A Study of Panitumumab Efficacy and Safety Compared to Cetuximab in Patients With KRAS Wild-Type Metastatic Colorectal Cancer), a Phase III, head-to-head randomized noninferiority study comparing the efficacy and safety of panitumumab and cetuximab in this population. Methods A decision-analytic model was developed to perform a cost-minimization analysis and a semi-Markov model was created to evaluate the cost-effectiveness of panitumumab monotherapy versus cetuximab monotherapy in chemotherapy-resistant wild-type KRAS (exon 2) mCRC. The cost-minimization model assumed equivalent efficacy (progression-free survival) based on data from ASPECCT. The cost-effectiveness analysis was conducted with the full information (uncertainty) from ASPECCT. Both analyses were conducted from a US third-party payer perspective and calculated average anti–epidermal growth factor receptor doses from ASPECCT. Costs associated with drug acquisition, treatment administration (every 2 weeks for panitumumab, weekly for cetuximab), and incidence of infusion reactions were estimated in both models. The cost-effectiveness model also included physician visits, disease progression monitoring, best supportive care, and end-of-life costs and utility weights estimated from EuroQol 5-Dimension questionnaire responses from ASPECCT. Findings The cost-minimization model results demonstrated lower projected costs for patients who received panitumumab versus cetuximab, with a projected cost savings of $9468 (16.5%) per panitumumab-treated patient. In the cost-effectiveness model, the incremental cost per quality-adjusted life-year gained revealed panitumumab to be less costly, with marginally better outcomes than cetuximab. Implications These economic analyses comparing panitumumab and cetuximab in chemorefractory wild-type KRAS (exon 2) mCRC suggest benefits in favor of panitumumab. ClinicalTrials.gov identifier: NCT01001377.

To compare the costs of first-line treatment with panitumumab + FOLFOX in comparison to cetuximab + FOLFIRI among patients with wild-type (WT) RAS metastatic colorectal cancer (mCRC) in the US.A cost-minimization model was developed assuming similar treatment efficacy between both regimens. The model estimated the costs associated with drug acquisition, treatment administration frequency (every 2 weeks for panitumumab, weekly for cetuximab), and incidence of infusion reactions. Average anti-EGFR doses were calculated from the ASPECCT clinical trial, and average doses of chemotherapy regimens were based on product labels. Using the medical component of the consumer price index, adverse event costs were inflated to 2014 US dollars, and all other costs were reported in 2014 US dollars. The time horizon for the model was based on average first-line progression-free survival of a WT RAS patient, estimated from parametric survival analyses of PRIME clinical trial data.Relative to cetuximab + FOLFIRI in the first-line treatment of WT RAS mCRC, the cost-minimization model demonstrated lower projected drug acquisition, administration, and adverse event costs for patients who received panitumumab + FOLFOX. The overall cost per patient for first-line treatment was $179,219 for panitumumab + FOLFOX vs $202,344 for cetuximab + FOLFIRI, resulting in a per-patient saving of $23,125 (11.4%) in favor of panitumumab + FOLFOX.From a value perspective, the cost-minimization model supports panitumumab + FOLFOX instead of cetuximab + FOLFIRI as the preferred first-line treatment of WT RAS mCRC patients requiring systemic therapy.

Background: Using data from the phase IIb POWER trials, darunavir boosted with low-dose ritonavir (DRV/r; 600/100 mg twice daily; bid)-based highly active antiretroviral therapy (HAART) was shown to be significantly more efficacious and cost effective than other protease inhibitor (PI)-based therapy in highly treatment-experienced, HIV-1-infected adults. Furthermore, in the phase III TITAN trial (TMC114-C214), DRV/r 600/100 mg bid-based HAART generated a superior 48-week virological response rate compared with standard-of-care lopinavir/ritonavir (LPV/r; 400/100 mg bid)-based therapy in treatment-experienced, lopinavir-naive patients, and in particular those with one or more International AIDS Society - USA (IAS-USA) primary PI resistance-associated mutations at baseline. These patients had a broader degree of previous PI use/failure (0-≥2) than the POWER patients. Objectives: To determine whether DRV/r 600/100 mg bid-based HAART is cost effective compared with LPV/r-based therapy, from the perspective of Belgian, Italian, Swedish and UK reimbursement authorities, when used in treatment-experienced patients similar to TITAN patients with one or more IAS-USA primary PI mutations at baseline. Methods: An existing Markov model containing health states defined by CD4 cell count ranges (>500, 351-500, 201-350, 101-200, 51-100 and 0-50 cells/mm) and an absorbing state of death was adapted for use in the above-mentioned healthcare settings. Baseline demographics, CD4 cell count distribution, antiretroviral drug usage, virological/immunological response rates and matching transition probabilities were based on data collected during the first 48 weeks of therapy in the modelled subgroup of TITAN patients and the published literature. After treatment failure, patients were assumed to switch to a follow-on combination regimen. For each health state, utility values and mortality rates were obtained from the published literature. Data from local observational studies (Belgium, Sweden and Italy) or the published literature (UK) were used to determine resource-use patterns and costs associated with each CD4 cell count range. Unit costs were derived from official local sources; a lifetime horizon was taken and discount rates were chosen based on local guidelines. Results: The base-case analysis predicted quality-adjusted life year (QALY) gains of 0.785 in Belgium, 0.608 in Italy, 0.584 in Sweden and 0.550 in the UK when DRV/r-based therapy was used instead of LPV/r-based treatment. The estimated base-case incremental cost-effectiveness ratios (ICERs) were &U20AC;6964/QALY gained in Belgium, &U20AC;9277/QALY gained in Italy, &U20AC;6868 (SEK69 687)/QALY gained in Sweden and &U20AC;14 778 (£12 612)/QALY gained in the UK. Assuming a threshold of &U20AC;30 000/QALY gained, DRV/r-based therapy remained cost effective over most parameter ranges tested in extensive one-way sensitivity analyses. The variation of immunological response rates and the time horizon were identified as important drivers of cost effectiveness. Probabilistic sensitivity analysis revealed a greater than 70% probability of achieving an ICER below this threshold in all four healthcare settings. Conclusion: From the perspective of Belgian, Italian, Swedish and UK payers, DRV/r 600/100 mg bid-based HAART is predicted to be cost effective compared with LPV/r 400/100 mg bid-based therapy, when used to manage treatment experienced, lopinavir-naive, PI-resistant, HIV-infected adults with a broad range of previous PI use/failure.

Objectives: Asynchrony between patient and ventilator breaths is associated with increased duration of mechanical ventilation (MV). Neurally Adjusted Ventilatory Assist (NAVA) controls MV through an esophageal reading of diaphragm electrical activity via a nasogastric tube mounted with electrode rings. NAVA has been shown to decrease asynchrony in comparison to pressure support ventilation (PSV). The objective of this study was to conduct a health economic evaluation of NAVA compared with PSV. Methods: We developed a model based on an indirect link between improved synchrony with NAVA versus PSV and fewer days spent on MV in synchronous patients. Unit costs for MV were obtained from the Swedish intensive care unit register, and used in the model along with NAVA-specific costs. The importance of each parameter (proportion of asynchronous patients, costs, and average MV duration) for the overall results was evaluated through sensitivity analyses. Results: Base case results showed that 21% of patients ventilated with NAVA were asynchronous versus 52% of patients receiving PSV. This equals an absolute difference of 31% and an average of 1.7 days less on MV and a total cost saving of US$7886 (including NAVA catheter costs). A breakeven analysis suggested that NAVA was cost effective compared with PSV given an absolute difference in the proportion of asynchronous patients greater than 2.5% (49.5% versus 52% asynchronous patients with NAVA and PSV, respectively). The base case results were stable to changes in parameters, such as difference in asynchrony, duration of ventilation and daily intensive care unit costs. Conclusion: This study showed economically favorable results for NAVA versus PSV. Our results show that only a minor decrease in the proportion of asynchronous patients with NAVA is needed for investments to pay off and generate savings. Future studies need to confirm this result by directly relating improved synchrony to the number of days on MV.

A long-term cost-effectiveness model for early decision-making and estimation of outcomes of novel therapeutic procedures for Parkinson's disease (PD) was developed based on the Hoehn and Yahr (HY) stages of PD. Results provided support for model validity. Model application to a future dopamine cell replacement therapy indicated long-term cost offsets and gains in quality-adjusted life years (QALYs) in early onset PD (HY III-IV), as compared to standard drug therapy. The maximum price premium (i.e., profit or compensation for developmental costs) for the intervention to remain cost-effective was estimated to EURO12000-64000 according to cost-per-QALY thresholds of EURO38000-70000 and depending on whether all or only medical direct costs are considered. The study illustrates the value of early health economic modeling and the described model shows promise as a means to estimate outcomes and aid decision-making regarding novel interventions for PD. (c) 2006 Elsevier Ltd. All rights reserved.

Three methodological approaches were applied to analyze whether the cost-effectiveness of drotrecogin alfa (activated) (Xigris) as an adjunct to standard care compared with standard care alone is a cost-effective alternative for the treatment of Swedish patients with severe sepsis and organ dysfunction. Health-economic model simulations were applied to (1) Swedish treatment pattern data, (2) international trial data and local unit prices, and (3) Swedish local patient data combined with trial age structure to adjust for differences in the age structure between the trial and the Swedish patient sample. The methodological approach had no effect on the overall conclusion that the intervention was cost-effective in the treatment of Swedish patients with severe sepsis and organ dysfunction. However, the cost-effectiveness ratios were sensitive to the approach applied. The results indicate the importance of collecting not only information on local prices but also information about treatment pattern and patient characteristics when conducting country-specific health-economic model applications.

The aim of this study was to estimate costs of treating venous leg ulcers in Sweden and the United Kingdom during 1 year and to quantify costs in different health states. The costs of treating four different types of venous leg ulcers were estimated for 52 weeks by a stochastic health economic model, which simulated resource use data obtained from prospectively collected patient data, expert panels in the two countries, and published scientific literature. The average cost of treating an ulcer varied between 1332 Euro and 2585 Euro in Sweden and from 814 Euro to 1994 Euro in the United Kingdom. Cost of treating large ulcers (>/= 10 cm(2)) of long duration (>/= 6 months) was highest in both countries. Frequency of dressing changes and duration of time for each dressing change were higher in Sweden than in the United Kingdom, resulting in higher total cost per patient in Sweden. An important factor for the total costs was time to heal. Other important variables influencing treatment costs were frequency and duration of dressing changes. Actions to reduce time used for dressing changes and the total time to healing are thus very important in reducing costs spent on treatment of venous leg ulcers in both countries.

An estimate of the average cost of treatment (COT) was assessed for 53 patients with pancreatic cancer treated between 1997 and 1999 in four hospitals in southern Sweden. Average COT was estimated to Euro18 947, 55% of which was attributable to hospitalization (including surgical procedures), 20% to long-term care and 11% to chemotherapy. Diagnostics and radiotherapy accounted for 9% and 4%, respectively. Median survival was 5.6 months (mean 6.3 months). Treatment costs per patient were negatively correlated with age but were higher for patients receiving chemo/radiotherapy and surgical treatment than for patients receiving only standard supportive care. Disease stage and type of hospital (university versus regional/local hospitals) were not significant predictors of COT per se. Assuming that our estimate of the average cost is representative for Sweden, the total healthcare cost for pancreatic cancer was Euro16 million (dollar14 million), i.e about 2-3% of the COT for all cancer diseases in Sweden. In the USA the cost of pancreatic cancer accounted for the same proportion. However, our estimated cost per patient was about half the amount of the US estimate. The distribution of costs between the different types of treatment services did not differ greatly between Sweden and the USA.

BACKGROUND: The choice between different attention-deficit/hyperactivity disorder (ADHD) medications depends on different drug attributes. Economic evaluations of drugs often disregard the utility of other attributes compare with the drugs' efficacy.AIMS: The aim of this study was to assess patient's preferences and elicit willingness-to-pay (WTP) for different drug attributes in the treatment of ADHD.METHODS: 285 patients (117 parents for children below 15 years, 52 adolescents 15-17 years and 116 adults aged 18 years and above) from Sweden, Denmark and Norway completed a questionnaire concerning their ADHD drug treatment, and answered questions on their preferences using a discrete choice experiment (DCE). Included attributes were effectiveness, side-effects, dosing and price.RESULTS: Effectiveness was the most important attribute, followed by side-effects and the number of dosings per day (all P < 0.001). The estimated monthly WTP for a drug generating full effectiveness, no side-effects and once-daily dosing was €790 for adolescents and €360 for adults. The estimated WTP for ADHD drugs with characteristics similar to existing drugs on the market was higher or in line with market prices (€37-180 for adolescents and €16-80 for adults). Regarding experience with current treatment, 19% of all patients in the study reported good functioning during the morning, day and evening.CONCLUSIONS: The gap between the monetary valuation of existing products and an optimally valued product suggest that there is room for improvements in the clinical management of ADHD. The results suggest that DCE is a method that can be used to value not only hypothetical scenarios but also can be used to value and distinguish between real-life scenarios.

PMH67 DRUG UTILISATION ADAPTATIONS IN SWEDEN AFTER THE EFFEXOR PATENT EXPIRY Bruce S1, Hjelmgren J2, Lofroth E1, Myren KJ3 1IMS Health, Stockholm, Sweden, 2IMS Health Sweden AB, Stockholm, Sweden, 3IMS Health, Stockholm, Stockholm, Sweden OBJECTIVES: Here, we evaluated the effect of the Effexor (N06AX16) patent expiry in Sweden. The aim was to see if adaptations, such as generic penetration, increased new prescriptions, or switches from other SNRIs, could be seen when evaluating all dispatches in the year before (2008) and after (2009) the patent expiry. METHODS: We used the CEBRxA database, which combines data from the national Swedish drug registry, with a public claims database for the South-West region of Sweden, comprising around 1.5 million individuals. For the generic penetration analysis, all prevalent patients were selected. For the longitudinal analysis, all patients who had made at least 2 dispatches of any antidepressant (N06A*) were selected and a 6 months washout-period was applied. Subsequently, all dispatches were annotated, at the ATC level, as either new (no other antidepressants within 105 days), add-on (specific antidepressant dispatched both before and after), switch (specific antidepressant dispatched before, but not after), or continuation (dispatched same ATC-code within 105 days). RESULTS: Of all N06AX16 dispatches in 2009, 81% corresponded to generic Venlafaxin, and the remaining 19% corresponded to branded Effexor. However, the prevalent patient counts decreased from 12,467 in 2008, to 12,248 in 2009. This trend was opposite to that of other SNRIs; generic Mirtazapine (N06AX11) and branded Cymbalta (N06AX21) both increased by three and 10 percent, respectively. Amongst the incident population, only minor differences were observed when comparing the proportion of dispatches with evidence of a new treatment, switch or add-on, between 2008 and 2009 for N06AX16. CONCLUSIONS: Al though generic penetration was quite efficient, we did not observe an increased proportion of patients switching to, or new prescriptions for, generic Venlafaxin during 2009. This can to some extent be explained by the expiry date on prescriptions, extending into 2009, while the decreasing prevalent patient population suggests additional dimensionality.

Patient registries often lack indicators of the disease as experienced by patients, e.g. treatment satisfaction and self-assessed disease severity. There is scarce information about the relationship between these assessments and currently existing instruments used in treatment evaluation. Our objective was to explore the importance of these indicators among patients with psoriasis in Finland and Sweden, in relation to treatment patterns and current measures of health-related quality of life. Data were collected from a patient survey and a retrospective chart review for 273 patients over 12 months. To assess psoriasis treatment completely, it is necessary to consider the impact of the disease on the patient in terms of treatment satisfaction, disease severity and health-related quality of life. The individual disease burden on patients should play a central role in formulating treatment goals. Clinician- and patient-based perspectives of the overall impact of psoriasis can assist clinical decision-making and evaluations of treatments.

Background Atopic dermatitis (AD) affects health and quality of life (QoL) and also has great impact on both healthcare costs and costs to society. Objectives The aim of the study was to analyse the cost-effectiveness of treatment with tacrolimus ointment vs. standard treatment in patients with moderate to severe AD. Methods A Markov simulation model was constructed capturing several key features of AD and its treatment: disease severity, treatment alternatives, and QoL. The model was populated with data from three sources: (i) efficacy data from a randomized controlled trial including patients with moderate to severe AD treated with either tacrolimus ointment or standard treatment (corticosteroids), (ii) resource utilization and QoL data from a patient survey including 161 Swedish patients with AD, and (iii) official price lists. Costs were calculated according to disease severity for the two treatment alternatives using the perspective of the Swedish healthcare sector. Two analyses were performed, one based on the quantity of medication used in the trial and one based on the survey data. The relationship between effectiveness of tacrolimus ointment and the amount of medication used was tested in sensitivity analyses. Results In the model simulations patients with severe AD treated with tacrolimus ointment experienced on average 4.6 more AD-free weeks per year than patients given standard treatment. The corresponding figure for patients with moderate AD was 6.5 more AD-free weeks per year. The cost-effectiveness ratios [cost per Quality Adjusted Life Year (QALY) gained] for treatment with tacrolimus ointment vs. standard treatment were 2334 pound for moderate AD and 3875 pound for severe AD when treatment patterns from the survey were assumed, and 8269 pound for moderate AD and 12 pound 304 for severe AD when treatment patterns from the clinical trial were assumed. The results of sensitivity analyses were all well within limits to be considered cost-effective. Conclusions Estimates of the incremental cost-effectiveness ratio are far below the currently discussed threshold in Sweden, corresponding to approximately 48 pound 700 per QALY gained, and equivalent thresholds in other countries. Treatment with tacrolimus ointment in patients with moderate and severe AD can therefore be considered cost-effective. (Less)

Lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) are a common condition in men, and their incidence increases with age. The objective of this study was to evaluate the potential cost-utility of microwave thermotherapy, specifically the ProstaLund Feedback Treatment (PLFT), versus alpha-blockade in Swedish patients with LUTS due to BPH.A health-economic simulation model, based on long-term disease progression and costs, was developed to analyse the cost-utility of PLFT in comparison with alpha-blockade over a 3-year period based on data from published literature, treatment programmes and official price lists. Outcome measures used in the analysis were quality of life, survival and reduction in International Prostate Symptom Score. Sensitivity analyses were performed for a number of essential variables. The perspective of the study is the healthcare sector. All costs are expressed as 2003 prices.Three years after an intervention with PLFT or initiation of drug treatment the cost-utility of PLFT was estimated at approximately euro 6600-9500 per quality-adjusted life-year gained. The cost-utility was further improved over a longer time period, and PLFT appears to be cost-saving after 5 years. One important finding from the model simulation was that PLFT also seems to be favourable in patients with less pronounced symptoms. This result may be further validated when additional results from controlled clinical trials become available.The present model simulation indicates that treatment with PLFT seems to be cost-effective compared with drug therapy with alpha-blockade. The result shows that the time-frame of the analysis has a great impact on the cost-effectiveness ratio.

Objective: To examine which attributes are important when individuals choose between primary care models. In particular, we studied whether individuals that were given a choice preferred individual family physicians (GP) or a primary care team consisting of physicians and nurses (PCT). Method: A questionnaire survey, designed as a discrete choice experiment, was sent to 1600 individuals in Sweden. In the questionnaire, different primary care models were constructed on the basis of five attributes: GP versus primary care team, waiting time for non-emergency visits, user charges, ability to choose provider, and degree of influence over the care received. Individual preferences and willingness to pay for attributes were regressed against such characteristics as age, gender, education, and health status (as measured by EQ-5D). Results: The response rate was 58%. Waiting time, user charges, ability to choose provider, and degree of influence over the care received were each statistically significant discriminants (p < 0.001). Willingness to pay per visit was 224 SEK for great compared to limited degree of influence over the care received, 164 SEK for ability to choose a provider and 111 SEK for each 1 day reduction in waiting time for non-emergency visits. Subgroup analysis showed that older individuals and individuals in poor health preferred the option to register with a GP whereas working individuals and individuals living at a greater distance from a hospital preferred the option to register with a primary care team. © 2007 Elsevier Ireland Ltd. All rights reserved.

Annual costs for the treatment of venous leg ulcers in Sweden have been estimated at between SEK 17,000 and SEK 26,500 per patient in 2002 prices. The calculation was based on a model simulation including data from a follow-up of patients in clinical practice, an expert panel, and published literature. The variation in costs depends on ulcer size and ulcer duration when treatment is initiated. The highest costs were estimated for a group of patients with ulcers 10 cm2 or larger and ulcer duration of 6 months or longer. About 50 per cent of the total annual costs were related to staff costs for dressing changes.

Weekly resource use data for local wound treatment was collected from a clinical survey (138 patients). Annual costs were calculated from the weekly resource usage multiplied by unit costs and published epidemiological prevalence data for Sweden. The average weekly cost was 101 euro, though it differed depending by ulcer size. The total direct annual cost of venous leg ulcers in Sweden could be estimated at 73 million euro (2002 prices, 1 euro = SEK 9.16) based on a point prevalence of 0.3 percent and 45 percent venous ulcers. Treatment of leg ulcers seems to have improved compared with previous reports, resulting in slightly decreased costs. Nevertheless, the costs are still substantial and the management of these patients requires large resources. A more structured management, more careful selection of dressing products and decreased frequency of dressing changes imply further improvements in wound healing and quality of life for patients and decreased costs for the health care system and for society.

The study aims to compare health care utilisation and workdays lost for individuals with and without asthma in Sweden. Individual data on self-perceived asthma problems, self-reported utilisation of outpatient care and official data on inpatient care, and official data on workdays lost was obtained from the HILDA database (health and individuals: longitudinal data and analysis). The study covered 13,000 individuals. Independent t-tests were performed to compare average differences in primary care visits, emergency room visits, days in hospital and workdays lost. Individuals with severe asthma, as compared with the general population, were found to utilise primary care visits, emergency room visits and hospitalisation according to the following ratios: 1.9(:1), 4.9 and 4.3 per year, respectively. For workdays lost the ratio was 1.9. All differences were statistically significant. For individuals reporting mild asthma, no significant differences were found compared with the general population. This finding may be due to the success of asthma management in this population. Both the official data and the self-reported data provided evidence of the burden of asthma to individuals and society. Briefly, self-reported severe asthmatics utilised 2-5 times more resources than the general population, while there were no differences in resource utilisation between self-reported mild asthmatics and the general population.

of all dressing changes were performed by nurses or auxiliary nurses in primary health care or home health care. Surgical procedures (pinch graft, skin grafting, venous vascular surgery) had been undertaken in 22% of the patients. The average weekly cost was €114, though it differed depending by ulcer size. For ulcers

Objective To classify, summarize, and compare the health economic guidelines (HE) issued in Europe, North America, and Australia to clarify similarities and differences between them. Materials and Methods In a literature review HE guidelines were classified according to whether they were 1) formalized, 2) informal, or 3) guidelines for health economic methods. All the guidelines were summarized in a table format according to 15 important methodological aspects. The aspects were compared both within and between the three groups. Results A total of 25 guidelines were identified, seven formalized, eight informal, and 10 guidelines for HE methods. The levels of agreement for methodological aspects within groups were 40% to 100%, 25% to 100% and 30% to 100% for the formalized, informal, and HE guidelines, respectively. The formal guidelines were slightly more homogenous than the other groups. The between-group comparison showed that the guidelines were in agreement for about 75% of methodological aspects. Disagreement between guidelines was found in choice of perspective, resources, and costs that should be included in the analysis, and in methods of evaluating resources used. Conclusion A harmonization of methodological requirements and recommendations exists both within and between the guideline groups. This review provides information concerning the core of agreements that have been reached. A number of policy implications for various parties, mainly the pharmaceutical industry, were identified.

Objective To investigate the cost-effectiveness of panitumumab plus mFOLFOX6 (oxaliplatin, 5-fluorouracil and leucovorin) compared with bevacizumab plus mFOLFOX6 in first-line treatment of patients with wild-type RAS metastatic colorectal cancer (mCRC). Design A semi-Markov model was constructed from a French health collective perspective, with health states related to first-line treatment (progression-free), disease progression with and without subsequent active treatment, resection of metastases, disease-free after successful resection and death. Methods Parametric survival analyses of patient-level progression-free and overall survival data from the only head-to-head clinical trial of panitumumab and bevacizumab (PEAK) were performed to estimate transitions to disease progression and death. Additional data from PEAK informed the amount of each drug consumed, duration of therapy, subsequent therapy use, and toxicities related to mCRC treatment. Literature and French public data sources were used to estimate unit costs associated with treatment and duration of subsequent active therapies. Utility weights were calculated from patient-level data from panitumumab trials in the first-, second- and third-line settings. A life-time perspective was applied. Scenario, one-way, and probabilistic sensitivity analyses were performed. Results Based on a head-to-head clinical trial that demonstrates better efficacy outcomes for patients with wild-type RAS mCRC who receive panitumumab plus mFOLFOX6 versus bevacizumab plus mFOLFOX6, the incremental cost per life-year gained was estimated to be €26,918, and the incremental cost per quality-adjusted life year (QALY) gained was estimated to be €36,577. Sensitivity analyses indicate the model is robust to alternative parameters and assumptions. Conclusions The incremental cost per QALY gained indicates that panitumumab plus mFOLFOX6 represents good value for money in comparison to bevacizumab plus mFOLFOX6 and, with a willingness-to-pay ranging from €40,000 to €60,000, can be considered cost-effective in first-line treatment of patients with wild-type RAS mCRC.