The budget impact of monoclonal antibodies used to treat metastatic colorectal cancer in Minas Gerais, Brazil

da Silva, Wânia Cristina and Godman, Brian and de Assis Acúrcio, Francisco and Cherchiglia, Mariangela Leal and Martin, Antony and Maruszczyk, Konrad and Izidoro, Jans Bastos and Portela, Marcos André and Lana, Agner Pereira and Neto, Orozimbo Henriques Campos and Gurgel Andrade, Eli Iola (2020) The budget impact of monoclonal antibodies used to treat metastatic colorectal cancer in Minas Gerais, Brazil. Applied Health Economics and Health Policy. ISSN 1179-1896 (In Press)

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    Introduction: Biological medicines have increased the cost of cancer treatment and has raised sustainability concerns. In Brazil, three monoclonal antibodies (MABs): bevacizumab (BEVA), cetuximab (CETUX) and panitumumab (PANIT), are indicated for the treatment of metastatic colorectal cancer (mCRC) but currently not currently funded by the Unified Health System (SUS). However, they have been funded following successful litigation cases. Objective: Evaluate the budget impact of BEVA, CETUX and PANIT MABs if they became part of standard chemotherapy to treat mCRC within the SUS of Minas Gerais (MG), in Brazil. Method: Budget impact analysis incorporating MABs as first-line treatment of mCRC in MG/Brazil was explored. The Brazilian health system – SUS perspective was adopted and a 5-year time horizon was applied. Data from the lawsuits from January 2009 to December 2016 were collected and the model was populated based national databases and published sources. Costs are expressed in USD. Results: 351 court lawsuits were granted for first-line MAB treatment for mCRC. In three alternative scenarios analyzed there was an increase in costs, which ranged from 348 to 395% compared to the reference scenario. PANIT presented a $103,360,980 budget impact compared to the reference scenario over a 5-year time horizon. BEVA and CETUX presented a $111,334,890 and $113,772,870 budget impact, respectively. Considering the restrictions on the use of MABs Anti EGFR (CETUX and PANIT) in patients with about 41% KRAS mutations, the best cost alternative adopted for incorporation should be the combination of the PANIT and BEVA antibodies, which demonstrated a cost of approximately $106 million. Conclusion: These results highlight the appreciable costs for incorporating BEVA, CETUX and PANIT into the SUS. It is likely appreciable discounts will be needed to permit incorporation.