Efficiency of nimotuzumab in the health care of patients with head and neck cancer. Cuba 2009-2013

[Speaker] Leslie Perez Ruiz:1
[Co-author] Manual M.:2, Normando Izanaga Escobar:1, Anai Garcia Farinas:3, Osvaldo Ulises Garay:4
1:Center of Molecular Immunology (CIM), Havana, Cuba, 2:National Institute of Hygiene, Epidemiology and Microbiology (INHEM), Havana, Cuba, 3:National Public Health School (ENSAP), Havana, Cuba, 4:Sanitary Clinic Effectiveness Institute (IECS), Buenos Aires, Argentina

OBJECTIVES: To evaluate the efficiency of health care received by patients diagnosed with advanced squamous cell carcinoma of the head and neck (SCCHN) included in the phase IV clinical trial conducted in Cuba during 2009-2013. METHODS: A complete cost-effectiveness pharmacoeconomic evaluation was conducted using the database of the patients with SCCHN included during 2009-2013 in the open, no randomized, national, multicenter, clinical trial, phase IV. The universe was 386 patients included in this trial from 15 clinical sites. Five treatment options were evaluated: radiotherapy (RT) + nimotuzumab, concurrent RT / chemotherapy (CT) + nimotuzumab, sequential RT / CT + nimotuzumab, nimotuzumab monotherapy and CT + nimotuzumab. The main variable of effectiveness was overall survival. Direct health costs were estimated. A sensitivity analysis was carried out, taking into account the lower and upper limits of the CI 95% of the costs and the effectiveness, creating 4 scenarios. RESULTS: The most effective option was sequential radio-chemotherapy (RT-CT) + nimotuzumab with 2.53 years of life gained (YLG). The most efficient alternative was CT + nimotuzumab with an average cost-effectiveness ratio (ACER) of 26 450.20 CUP/LYG. The incremental cost-effectiveness ratio (ICER) of the sequential RT/CT + nimotuzumab option respects to CT + nimotuzumab was 33 119.63 CUP/LYG additional. According to CHOISE criteria, it is considered a not cost-effective option. The sensitivity analysis showed similar values, demonstrating the robustness of the results obtained. CONCLUSIONS: The sequential RT/CT + nimotuzumab option has greater effectiveness and lower efficiency than CT concurrent with nimotuzumab, so achieving greater survival in the treatment of patients with head and neck cancer in advanced stages means an additional cost to society.
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