Cost effectiveness of cetuximab concurrent with radiotherapy for patients with locally advanced head and neck cancer in Taiwan: A decision-tree analysis

Background: Concomitant chemotherapy with radiotherapy is considered to be the standard of care for patients with head and neck cancer and good performance status. However, published reports on the cost effectiveness of this therapeutic approach are extremely rare. Objective: The aim of this study was to estimate the cost effectiveness of cetuximab combined with radiotherapy compared with radiotherapy alone in patients with locally advanced squamous cell carcinoma of the head and neck. Methods: A decision-tree analysis was used to compare cetuximab combined with radiotherapy and radiotherapy alone in the treatment of patients with locally advanced squamous cell carcinoma of the head and neck from the perspective of the national health payer (the Bureau of National Health Insurance [BNHI]) in Taiwan. The model was based on individual patient data extracted from an international phase III trial. The direct medical costs of care were estimated by clinical expert panels based on the reimbursement price of the BNHI (2007 values). One-way sensitivity analyses were performed while varying the costs and clinical parameters. Results: The incremental cost per quality-adjusted life-year (QALY) for patients receiving radiotherapy in combination with cetuximab compared with radiotherapy alone was $US36 992/QALY in the base-case analysis (2007 values). The sensitivity analysis showed the highest net benefit for radiotherapy alone if the cost of cetuximab increased by 50%. Conclusion: This study demonstrated that the addition of cetuximab to highdose radiotherapy regimens is likely to be cost effective in Taiwan because the incremental cost per QALYis below the commonly accepted cost-effectiveness threshold.