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The Budget Impact of Monoclonal Antibodies Used to Treat Metastatic Colorectal Cancer in Minas Gerais, Brazil

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Abstract

Introduction

Biological medicines have increased the cost of cancer treatments, which also raises concerns about sustainability. In Brazil, three monoclonal antibodies (mAbs)—bevacizumab, cetuximab, and panitumumab—are indicated for the treatment of metastatic colorectal cancer (mCRC) but not currently funded by the Unified Health System (SUS). However, successful litigation has led to funding in some cases.

Objective

Our objective was to evaluate the budgetary impact of including the mAbs bevacizumab, cetuximab, and panitumumab in standard chemotherapy for the treatment of mCRC within the SUS of Minas Gerais (MG), Brazil.

Method

A budget impact analysis of incorporating mAbs as first-line treatment of mCRC in MG was explored. The perspective taken was that of the Brazilian SUS, and a 5-year time horizon was applied. Data were collected from lawsuits undertaken between January 2009 and December 2016, and the model was populated with data from national databases and published sources. Costs are expressed in $US.

Results

In total, 351 lawsuits resulted in funding for first-line treatment with mAbs for mCRC. The three alternative scenarios analyzed resulted in cost increases of 348–395% compared with the reference scenario. The use of panitumumab had a budgetary impact of $US103,360,980 compared with the reference scenario over a 5-year time horizon, and bevacizumab and cetuximab had budgetary impacts of $US111,334,890 and 113,772,870, respectively. The use of the anti-epidermal growth factor receptor (EGFR) mAbs (cetuximab and panitumumab) is restricted to the approximately 41% of patients with KRAS mutations, so the best cost alternative for incorporation would be the combination of panitumumab and bevacizumab, with a cost of approximately $US106 million.

Conclusion

These results highlight the appreciable costs for incorporating bevacizumab, cetuximab, and panitumumab into the SUS. Appreciable discounts are likely to be necessary before incorporation of these mAbs is approved.

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Authors and Affiliations

  1. Postgraduate Program in Medicines and Pharmaceutical Services, School of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil

    Wânia Cristina da Silva, Francisco de Assis Acúrcio, Mariângela Leal Cherchiglia & Eli Iola Gurgel Andrade

  2. Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK

    Brian Godman

  3. Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden

    Brian Godman

  4. Health Economics Centre, University of Liverpool Management School, Liverpool, UK

    Brian Godman & Antony Martin

  5. Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa

    Brian Godman

  6. Postgraduate Program in Public Health, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil

    Francisco de Assis Acúrcio, Mariângela Leal Cherchiglia, Agner Pereira Lana & Eli Iola Gurgel Andrade

  7. Health Economics Services, Warsaw, Poland

    Konrad Maruszczyk

  8. Divisão de Medicamentos Essenciais, Departamento de Assistência Farmacêutica, Secretaria de Estado de Saúde de Minas Gerais, Belo Horizonte, Brazil

    Jans Bastos Izidoro

  9. Mario Penna Institute of Oncology-Minas Gerais, Belo Horizonte, Brazil

    Marcos André Portella

  10. Associate Professor of Undergraduate Pharmacy, Faculdade Ciências da Vida (FCV), Sete Lagoas, Brazil

    Orozimbo Henriques Campos Neto

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  1. Wânia Cristina da Silva
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  7. Jans Bastos Izidoro
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  11. Eli Iola Gurgel Andrade
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Corresponding author

Correspondence to Wânia Cristina da Silva.

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Funding

This research was supported by the Research Group on Health Economics (GPES) UFMG and is an integral part of the research projects, “Analise do impacto orçamentário no Sistema Único de Saúde (SUS) de incorporação dos medicamentos mais demandados pela via judicial nos Programas de Assistência Farmacêutica” and “Avaliação Epidemiológica, econômica e de trajetórias assistenciais de procedimentos de alto custo no SUS: utilização de base de dados centrada no paciente a partir da integração de registros dos sistemas de informação em saúde” with financial support from the National Council for Scientific and Technological Development (FAPEMIG), the National Council for Scientific and Technological Development (CNPq) and Coordination for the Improvement of Higher Education Personnel (CAPES).

Conflicts of interest

Wânia Cristina da Silva, Brian Godman, Francisco de Assis Acúrcio, Mariângela Leal Cherchiglia, Antony Martin, Konrad Maruszczyk, Jans Bastos Izidoro, Marcos André Portella, Agner Pereira Lana, Orozimbo Henriques Campos Neto, and Eli Iola Gurgel Andrade have no conflicts of interest that are directly relevant to the content of this article.

Ethics approval

Not applicable.

Consent for publication

Not applicable.

Consent to participate

Not applicable.

Data availability

The major SUS Information Systems: Outpatient (SIA), Hospital (SIH) and Mortality (SIM), which contain approximately 3.5 million patients in cancer treatment, are not available publicly. Their access is restricted and only allowed through a data usage agreement that has a non-disclosure provision.

Author Contributions

WCS, BG, MLC, FAA, and EIGA conceived of and designed the paper and collected the data. AM, KM, and BG were involved in the writing or critical review of the paper, with important intellectual contributions and collection of some information. All authors analyzed, interpreted the data with substantial contribution, and approved the final version of the article for submission. WCS acts as guarantor that all aspects that make up the manuscript have been reviewed, discussed, and agreed among the authors in order to be exposed with maximum precision and integrity.

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da Silva, W.C., Godman, B., de Assis Acúrcio, F. et al. The Budget Impact of Monoclonal Antibodies Used to Treat Metastatic Colorectal Cancer in Minas Gerais, Brazil. Appl Health Econ Health Policy 19, 557–577 (2021). https://doi.org/10.1007/s40258-020-00626-0

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  • DOI: https://doi.org/10.1007/s40258-020-00626-0

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