Comparative net cost impact of the utilization of panitumumab versus cetuximab for the treatment of patients with metastatic colorectal cancer in Canada

Figures & data

Table 1. Calculated average EGFRi dose and number of vial requirements in each province.

	British Columbia	Alberta	Manitoba	Ontario	Québec
Panitumumab
Dose requirement	6 mg/kg × 70 kg^a= 420 mg over 60 min every 2 weeks 5 mL vial of 20 mg/mL = 100 mg per vial 5 vials required per infusion
No. of infusions	10	7	10	9	7
Cetuximab
Dose requirement	500 mg/m^2× 1.73 ^a m^2= 865 mg every 2 weeks, given over 120 min in cycle 1 and over 60 min thereafter 4 vials × 200 mg/100 mL plus 1 vial × 100 mg/50 mL	Initial dose: 400 mg/m^2× 1.73^a m^2= 692 mg over 120 min in week 1 3 vials × 200 mg/100 mL plus 1 vial × 100 mg/50 mL, or 7 vials × 100 mg/50 mL Subsequent weekly dose: 250 mg/m^2× 1.73 m^2= 433 mg over 60 min weekly 2 vials × 200 mg/100 mL plus 1 vial × 100 mg/50 mL, or 5 vials of 100 mg vials
No. of infusions	10	14	20	18	16
Pre-medication with cetuximab	Dexamethasone 8 mg oral plus 50 mg of diphenhydramine oral 45 min prior to cetuximab infusion	50 mg of diphenhydramine IV 45 min prior to cetuximab infusion
Irinotecan	180 mg/m^2 given over 90 min every 2 weeks for 10 infusions	Not reimbursed for combination	Not reimbursed for combination	180 mg/m^2 given over 90 min every 2 weeks for 9 infusions	Not reimbursed for combination
Pre-medication with irinotecan	None	None	None	Anzemet 100 mg IV, Decadron 10 mg IV, Atropine 0.4 mg/ml and Decadron 4 mg PO	None

^aThe average patient with mCRC was assumed to weigh 70 kg or have 1.73 m² of body surface area.

Table 2. Resources involved in the preparation and administration of the medications.

	British Columbia	Alberta	Manitoba	Ontario	Québec
Panitumumab
Drug preparation	Pharmacist time: • 30 min per script for patient file review and dose calculation of panitumumab  Assistant tech time: • 20 min per script for drug preparation	Pharmacist time: • 15 min per first script • 10 min for subsequent scripts  Assistant tech time: • 15 min per script for drug preparation	Pharmacist time: • 15 min per first script • 10 min for subsequent scripts  Assistant tech time: • 15 min per script for drug preparation	Pharmacist time: • 15 min per first script • 10 min for subsequent scripts • 15 min per script for drug preparation	Pharmacist time: • 15 min per first script • 10 min for subsequent scripts  Assistant tech time: • 15 min per script for drug preparation
Drug administration	Nursing time: • 30 min/infusion for IV line set up, injection access and removal, plus 15 min/infusion for supervision during infusion	Nursing time: • 30 min/infusion for IV line set up, injection access and removal, plus 15 min/infusion for supervision during infusion	Nursing time: • 30 min/infusion for IV line set up, injection access and removal, plus 15 min/infusion for supervision during infusion	Nursing time: • 30 min/infusion for IV line set up, injection access and removal, plus 15 min/infusion for supervision during infusion	Nursing time: • 30 min/infusion for IV line set up, injection access and removal, plus 15 min/infusion for supervision during infusion
	Medical supplies: 10 of each: • Needles (18G) and syringes (10 mL) • Second line IV infusion system • NaCl 0.9% solution (100 ml) • Filters 0.22 micron • Needles (22 G) and syringes (30 mL) • Paclitaxel infusion set	7 of each: • Needles and syringes • Second line IV infusion system • NaCl 0.9% solution (100 ml) • Filters	10 of each: • Needles and syringes • Second line IV infusion system • NaCl 0.9% solution (100 ml) • Filters	9 of each: • Needles and syringes • Second line IV infusion system • NaCl 0,9% solution (100 ml) • Dextrose 5% (250 ml)	7 of each: • Needles and syringes • Second line IV infusion system • NaCl 0.9% solution (100 ml) • Filters
	Infusion chair time:^a • 30 min/infusion for IV line set up, injection access and removal plus 60 min for drug infusion	Infusion chair time:^a • 30 min/infusion for IV line set up, injection access and removal plus 60 min for drug infusion	Infusion chair time:^a • 30 min/infusion for IV line set up, injection access and removal plus 60 min for drug infusion	Infusion chair time:^a • 30 min/infusion for IV line set up, injection access and removal plus 60 min for drug infusion	Infusion chair time:^a • 30 min/infusion for IV line set up, injection access and removal plus 60 min for drug infusion
Cetuximab
Drug preparation	Pharmacist time: • 30 min per script for patient file review and dose calculation of cetuximab and pre-medication Assistant technician time: • 30 min per script for drug preparation Nursing time: • 5 min review pre-medication script	Pharmacist time: • 20 min per first script • 10 min for subsequent scripts Assistant technician time: • 15 min per script for drug preparation Nursing time: • 5 min review premedication script	Pharmacist time: • 20 min per first script • 10 min for subsequent scripts Assistant technician time: • 15 min per script for drug preparation Nursing time: • 5 min review pre-medication script	Pharmacist time: • 20 min per first script for patient file review and dose calculation • 10 min for subsequent • 17 min for cetuximab and pre-medication preparation • 10 min for the first irinotecan script for patient file review and dose calculation • 4 min for subsequent scripts request • 17 min per script for irinotecan and pre-medication preparation	Pharmacist time: • 20 min per first script • 10 min for subsequent scripts Assistant technician time: • 17 min per script for drug preparation
Drug administration	Nursing time:  Per infusion: • 30 min for IV line set-up, injection access and removal • 30 min for supervision during the first drug infusion • 15 min during subsequent infusions	Per infusion: • 30 min for IV line set-up, injection access and removal • 30 min for supervision during the first drug infusion • 15 min during subsequent infusions • 10 min for pre-medication	Per infusion: • 30 min for IV line set-up, injection access and removal • 30 min for supervision during the first drug infusion • 15 min during subsequent infusions • 10 min for pre-medication	Per infusion: • 30 min for IV line set-up, injection access and removal • 30 min for supervision during the first drug infusion • 15 min during subsequent infusions • 10 min for pre-medication • 10 min for dextrose IV line set-up • 20 min for supervision during irinotecan • 10 min Anzemet administration • 1 min Decadron • 1 min atropine	Per infusion: • 30 min for IV line set-up, injection access and removal • 30 min for supervision during the first drug infusion • 15 min during subsequent infusions • 10 min for pre-medication
	Medical supplies: 50 of each: • Syringes, 60 mL • Chemo pins • Tip caps (non-luer lock) 10 of each: • Needles 18Gx1" • Syringes 10 mL • Second line IV infusion system • filters 0.22 micron • NaCl 0.9%, 50 mL • Viaflex bag, 250 mL • Paclitaxel set • Universal spike	28 of each: • Needles and syringes • Second line IV infusion system 14 of each: • Filters • Mini-bag NaCl • Viaflex bag, 500 mL	40 of each: • Needles and syringes • Second line IV infusion system • Filters 20 of each: • Mini-bag NaCl • Viaflex bag 500 mL	18 of each: • Primary IV line for NaCl • NaCl 0.9%, 250 mL 9 of each: • Primary IV lines for dextrose • Dextrose 5%, 250 mL Cetuximab plus pre-medication 36 of each: • Second IV lines for cetuximab and pre-medication • Needles, syringes • Filters, 22 micron 18 of each: • Viaflex bag 500 mL • mini-bags reg. NaCl 50 ml Irinotecan and its pre-medication 36 of each: • Syringes for irinotecan, Anzemet, Decadron, atropine 18 of each: • Second IV lines for irinotecan and Anzemet • Needles for irinotecan and Anzemet • Multi-ad luer caps 9 of each: • Filters for irinotecan • Needles 21G for irinotecan bag preparation • Dextrose 5%, 500 mL • NaCL 0.9%, 50 mL for Anzemet	32 of each: • Needles and syringes • Second line IV infusion system • Filters 16 of each: • Mini-bag NaCl • Viaflex bag, 500 mL
	Infusion chair time:^a Per infusion: • 30 min for IV line set-up, injection access and removal • 120 min for first infusion • 60 min for subsequent infusions • 45 min pre-medication infusion plus waiting time post-infusion • 90 min for Irinotecan	Per infusion: • 30 min for IV line set-up, injection access and removal • 120 min for first drug infusion • 60 min for subsequent infusions • 60 min pre-medication infusion plus waiting time post-infusion	Per infusion: • 30 min for IV line set-up, injection access and removal • 120 min for first drug infusion • 60 min for subsequent infusions • 60 min pre-medication infusion plus waiting time post-infusion	Per infusion: • 40 min for IV line set-up, injection access and removal and dextrose line set-up • 120 min for first drug infusion • 60 min for subsequent infusions • 60 min pre-medication infusion plus waiting time post-infusion • Irinotecan: 90 min • Antiemetic: 12 min	Per infusion: • 30 min for IV line set-up, injection access and removal • 120 min for first drug infusion • 60 min for subsequent infusions • 60 min pre-medication infusion plus waiting time post-infusion

^aInfusion chair time refers to overhead cost (maintenance, security, energy, hospital administration) for a chemotherapy department based on hemato-oncology department statistic data from an average size hospital in Québec9.

G, gauge; IV, intravenous; min, minute(s); NaCl, sodium chloride (saline).

Table 3. Patient follow-up and safety monitoring resources.

	British Columbia	Alberta	Manitoba	Ontario	Québec
Panitumumab
Personnel time per infusion	Nursing:  • 30 min for first education • 10 min for subsequent consultations • 8 min for blood withdrawal	Nursing: • 30 min for first education • 10 min for subsequent consultations Laboratory assistant: • 8 min for blood withdrawal		Nursing: • 30 min for first education • 10 min for subsequent consultations Phlebotomist: • 8 min for blood withdrawal	Pharmacist: • 30 min for first education • 10 min for subsequent consultations Nursing: • 8 min for blood withdrawal
Laboratory tests	At baseline: CBC, liver function • At each cycle and monthly for 2 months after last infusion: • Ca, Mg At each oncology visit: • Carcinoembryonic antigen (CEA) Every 8 weeks: • CT scan	Prior to each cycle: • CBC, Ca, Mg At each oncology visit: • Liver function and CEA Every 8 weeks: • CT scan		Prior to each cycle: • CBC, Ca, Mg At each oncology visit: • Liver function and CEA Every 8 weeks: • CT scan	Prior to each cycle: • CBC, Ca, Mg At each oncology visit: • Liver function and CEA Every 8 weeks: • CT scan
Cetuximab
Personnel time per infusion	Nursing: • 30 min for first education • 10 min for subsequent consultations • 15 min for monitoring patient after the end of each infusion • 8 min for blood withdrawal	Nursing: • 30 min for first education • 10 min for subsequent consultations • 15 min for monitoring patient after the end of each infusion Lab assistant: • 8 min for blood withdrawal		Nursing: • 30 min for first education • 10 min for subsequent consultations • 15 min for monitoring patient after the end of each infusion Phlebotomist: • 8 min for blood withdrawal	Pharmacist: • 30 min for first education • 10 min for subsequent consultations Nursing: • 15 min for monitoring patient after the end of each infusion Phlebotomist: • 8 min for blood withdrawal
Laboratory tests^a	At baseline: CBC, liver function • Prior to each cycle and monthly for 2 months after last infusion: • Ca, Mg At each oncology visit: • CEA Every 8 weeks: • CT scan	Prior to each cycle: • CBC, Ca, Mg At each oncology visit: • Liver function, CEA Every 8 weeks: • CT scan		Prior to each cycle: • CBC, Ca, Mg At each oncology visit: • Liver function, CEA Every 8 weeks: • CT scan	Prior to each cycle: • CBC, Ca, Mg At each oncology visit: • Liver function, CEA Every 8 weeks: • CT scan
Infusion chair time^b	Patients remain in chair for 60 min after each infusion of cetuximab	Patients remain in chair for 60 min after each infusion of cetuximab		Patients remain in chair for 60 min after each infusion of cetuximab	Patients remain in chair for 60 min after each infusion of cetuximab

^aDoes not include tests to monitor safety of irinotecan.

^bInfusion chair time refers to overhead cost (maintenance, security, energy, hospital administration) for a chemotherapy department based on hemato-oncology department statistic data from an average size hospital in Québec9.

Ca, calcium; CBC, complete blood count; CEA, carcinoembryonic antigen; CT, computed tomography; Mg, magnesium; min, minute(s).

Table 4. Resources utilized in managing adverse events related to EGFRi treatment.

	British Columbia	Alberta	Manitoba	Ontario	Québec
Treatments to manage adverse events
Infusion reaction (all grades) Incidences: Panitumumab, 3% Cetuximab, 21%	• Solumedrol IV 100 mg • Ranitidine 50 mg IV • 30 min nursing time	• Diphenhydramine 50 mg IV • 30 min nursing time	• Diphenhydramine 50 mg IV • 30 min for nursing time	• Diphenhydramine 50 mg IV • 30 min nursing time	• Diphenhydramine 50 mg IV • 60 min nursing time
Rash grade 1–2 Incidences: Panitumumab, 75%^a Cetuximab, 82%^b	• Hydrocortisone cream 1% • Clindamycin cream 2% • Minocycline 100 mg bid for 4 weeks	• Hydrocortisone cream 1% • Minocycline 100 mg bid for 8 weeks	• Hydrocortisone cream 1% • Minocycline 100 mg bid for 4 weeks • Clindamycin cream 2%	• Hydrocortisone cream 1% • Minocycline 100 mg bid for 4 weeks • Clindamycin lotion 1%	• Hydrocortisone cream 1% • Minocycline 100 mg bid for 4 weeks
Rash grade 3 Incidences: Panitumumab, 14%^a Cetuximab, 8%^b	• Hydrocortisone cream 1% • Clindamycin cream 2% • Minocycline 100 mg bid for 4 weeks	• Hydrocortisone cream 1% • Minocycline 100 mg bid for 8 weeks • Methylprednisolone 4 mg per day for 21 days	• Hydrocortisone cream 1% • Minocycline 100 mg bid for 4 weeks • Clindamycin cream 2%	• Hydrocortisone cream 1% • Minocycline 100 mg bid for 4 weeks • Clindamycin lotion 1% • Triamcinolone acetonide 0.1%	• Hydrocortisone cream 1% • Minocycline 100 mg bid for 4 weeks • Methylprednisolone 4 mg/day for 21 days
Hypomagnesemia grade 3–4^c Incidences: Panitumumab, 3% Cetuximab, 5.8%	• 2 g of Mg sulphate IV over 30 min every cycle At each infusion: • Chair time^d: 30 min • Nurse time: 7.5 min • Medical supplies: NaCl 0.9% 500 mL, needles, syringes, and second line IV infusion system	• 4 g of Mg sulphate IV over 3 h every week At each infusion: • Chair time^d: 180 min • Nurse time: 60 min • Medical supplies: NaCl 0.9% 500 mL, needles, syringes, and second line IV infusion system	• 5 g of Mg sulphate IV over 3 h every cycle At each infusion: • Chair time^d: 180 min • Nurse time: 60 min • Medical supplies: NaCl 0.9% 500 mL, needles, syringes, and second line IV infusion system	• 5 g of Mg sulphate IV over 3 h every cycle At each infusion: • Chair time^d: 180 min • Pharmacist time: 13 min • Nurse time: 60 min • Medical supplies: NaCl 0.9% 500 mL, needles, syringes, and second line IV infusion system	• 5 g Mg sulphate IV over 3 h every infusion At each infusion: • Chair time^d: 180 min • Pharmacist time: 5 min • Assistant technician time: 8 min • Nurse time: 60 min • Medical supplies: NaCl 0.9% 500 mL, needles, syringes, and second line IV infusion system

^aRash with panitumumab included all skin and subcutaneous tissue disorders.

^bRash with cetuximab included only acne, rash, maculopapular rash, pustular rash, dry skin, and exfoliative dermatitis.

^cThere were no data available for treatment duration or occurrence of grade 3/4 hypomagnesaemia; the analysis assumed that hypomagnesaemia occurs 3 weeks after the first infusion of EGFRi and patients would be treated with magnesium sulphate until the end of therapy. The total cost includes professional time, infusion chair time, and medical supplies.

^dInfusion chair time refers to overhead cost (maintenance, security, energy, hospital administration) for a chemotherapy department based on hemato-oncology department statistic data from an average size hospital in Québec9.

bid, twice daily; CBC, complete blood count; d, day; IV, intravenous; Mg, magnesium; min, minute(s); NaCl, sodium chloride (saline).

Table 5. Canadian provincial health resource unit costs.

Resource	Unit costs					Source
	BC	AB	MB	ON	QC
EGFRi and pre-medication drug costs
Panitumumab, 100 mg vial	$600.00					Amgen Canada
Cetuximab, 100 or 200 mg vial	$335.00 (100 mg) $670.00 (200 mg)					Bristol-Myers Squibb Canada
Pre-medication						Oncology department of each institution
With panitumumab	$0	$0	$0	$0	$0
With cetuximab	n/a	$57	$81	n/a	$59
With cetuximab + irinotecan	$23	n/a	n/a	$148	n/a
Irinotecan, per mg	$0.50	n/a	n/a	$0.50	n/a	Oncology department of each institution
Personnel hourly wage						Provincial health services collective agreements^a,b,c,d,e
Pharmacist	$51.95	$52.90	$53.95	$48.94	$44.79
Assistant pharmacy technician	$33.88	$32.81	$20.63	n/a	$18.15
Nursing	$43.56	$43.30	$49.90	$42.44	$39.36
Assistant laboratory technician	n/a	n/a	$22.48	n/a	n/a
Phlebotomist	n/a	n/a	n/a	$25.37	n/a
Medical supplies						Provincial hospital buying groups or cancer agency/board^f,g,h,i,j
With panitumumab	$256	$108	$98	$171	$51
With cetuximab	n/a	$369	$242	n/a	$271
With cetuximab + irinotecan	$511	n/a	n/a	$808	n/a
Infusion chair time^k per minute	$0.71					Hemato-oncology department statistical data from the Québec Ministry of Health9
Laboratory tests						Provincial Ministries of Health
Complete blood count	$10.88	$17.11	$11.95	$8.27	$1.30
Ca and Mg tests	$8.34	$32.87	$23.15	$5.18	$1.50
Liver function tests	$11.64	$88.52	$62.95	$28.47	$5.60
Carcinoembryonic antigen	$10.39	$54.78	$23.85	$25.00	$3.80
CT scan	$157.75	$480.97	$103.95	$250.00	$94.70

^aProvincial Agreement - Health Science professionals bargaining association and Health Employers Association of British Columbia.

^bAlberta Health Services Employees’ Collective Agreement, March 31, 2011.

^cCollective Agreement - Manitoba Association of Health Care Professionals and Winnipeg Regional Health Authority, March 31, 2010 and Collective Agreement - Winnipeg Regional Health Authority and Health Sciences Centre Nurses, March 31, 2010.

^dOntario Public Service Employees Union (OPSEU), March 1, 2012.

^eComité patronale de négociations de la santé et des services sociaux (CPNSSS) without social benefits.

^fBritish Columbia Cancer Agency.

^gAlberta Cross Cancer Institute.

^hCancer Care Manitoba.

ⁱBuyer’s group of Sunnybrook Hospital.

^jService d’approvisionnement de la Montérégie.

^kInfusion chair time refers to the overhead cost for a chemotherapy treatment and does not include nursing time.

Ca, calcium; CT, computed tomography; Mg, magnesium; n/a, not applicable.

Figure 1. Total per patient costs of managing mCRC with panitumumab vs cetuximab in Canadian provinces.

Table 6. Total per patient costs of managing mCRC with panitumumab vs cetuximab.

	Alberta		Manitoba		Québec
	Panitumumab (7 infusions)	Cetuximab (14 infusions)	Panitumumab (10 infusions)	Cetuximab (20 infusions)	Panitumumab (7 infusions)	Cetuximab (16 infusions)
EGFRi	$21,000	$24,120	$30,000	$34,170	$21,000	$27,470
Pre-medication	n/a	$57	n/a	$81	n/a	$59
Drug preparation & administration
Professional time	$351	$864	$520	$1177	$294	$796
Medical supplies	$108	$369	$98	$242	$51	$271
Infusion chair time	$447	$1534	$639	$2173	$447	$1747
Sub-total	$906	$2767	$1257	$3592	$792	$2814
Monitoring
Professional time	$88	$313	$130	$492	$91	$346
Laboratory tests	$1885	$2235	$1097	$1448	$247	$272
Infusion chair time	$0	$596	$0	$852	$0	$682
Sub-total	$1973	$3145	$1227	$2792	$338	$1300
Adverse events management
Infusion reactions	$1	$5	$1	$6	$1	$9
Rash grade 1 or 2	$92	$102	$73	$80	$32	$35
Rash grade 3	$18	$11	$14	$8	$14	$8
Hypomagnesemia grade 3 and 4	$27	$116	$29	$179	$27	$134
Sub-total	$138	$233	$116	$273	$73	$185
Total cost	$24,017	$30,321	$32,600	$40,908	$22,203	$31,828
Incremental cost of Cetuximab	$6304 (26% higher)		$8308 (25% higher)		$9625 (43% higher)

EGFRi, epidermal growth factor receptor inhibitor; mCRC, metastatic colorectal cancer.

Table 7. Total per patient costs of managing mCRC with panitumumab vs cetuximab plus irinotecan.

	British Columbia		Ontario
	Panitumumab (10 infusions)	Cetuximab plus Irinotecan (10 infusions)	Panitumumab (9 infusions)	Cetuximab (18 infusions) plus Irinotecan (9 infusions)
EGFRi	$30,000	$30,150	$27,000	$30,820
Irinotecan	n/a	$1700	n/a	$1530
Pre-medication	n/a	$23	n/a	$148
Drug preparation & administration
Professional time	$699	$803	$474	$1542
Medical supplies	$256	$511	$171	$808
Infusion chair time	$639	$1640	$575	$2675
Sub-total	$1594	$2954	$1220	$5025
Monitoring
Professional time	$93	$202	$108	$393
Laboratory tests	$469	$469	$888	$1009
Infusion chair time	$0	$426	$0	$767
Sub-total	$562	$1097	$997	$2170
Adverse events management
Infusion reactions	$1	$6	$1	$5
Rash grade 1 or 2	$54	$59	$43	$47
Rash grade 3	$10	$6	$7	$4
Hypomagnesemia grade 3 and 4	$45	$86	$39	$161
Sub-total	$110	$157	$90	$217
Total cost	$32,266	$36,081	$29,307	$39,910
Incremental cost of Cetuximab plus Irinotecan	$3815 (12% higher)		$10,603 (36% higher)

EGFRi, epidermal growth factor receptor inhibitor; mCRC, metastatic colorectal cancer.

Table 8. Sensitivity analyses – Alberta, Manitoba, and Québec.

	Alberta		Manitoba		Québec
	Panitumumab (7 infusions)	Cetuximab (14 infusions)	Panitumumab (10 infusions)	Cetuximab (20 infusions)	Panitumumab (7 infusions)	Cetuximab (16 infusions)
Cost of pre-medication was removed	$24,017	$29,375	$32,600	$39,673	$22,203	$30,821
All costs other than the cost of EGFRi were removed	$21,000	$24,120	$30,000	$34,170	$21,000	$27,470
Average patient body surface area of 1.5 m^2	$24,017	$25,631	$32,600	$34,208	$22,203	$26,468
Average patient body surface area of 1.9 m^2	$24,017	$30,656	$32,600	$41,243	$22,203	$32,163
Average patient body weight of 65 kg	$19,817	$30,321	$26,600	$40,908	$18,003	$31,828
Average patient body weight of 80 kg	$24,017	$30,321	$32,600	$40,908	$22,203	$31,828
Incorporation of ASPECCT adverse event rates	$24,003	$30,216	$32,600	$40,782	$22,217	$31,742
Range of incremental costs of Cetuximab plus Irinotecan	$1614–$10,504		$1608–$14,308		$4265–$13,825

EGFRi, epidermal growth factor receptor inhibitor; mCRC, metastatic colorectal cancer; ASPECCT, Study of panitumumab vs cetuximab in patients with chemotherapy-refractory wild-type KRAS exon 2 metastatic colorectal cancer8.

Table 9. Sensitivity analyses – British Columbia and Ontario.

	British Columbia		Ontario
	Panitumumab (10 infusions)	Cetuximab plus Irinotecan (10 infusions)	Panitumumab (9 infusions)	Cetuximab (18 infusions) plus Irinotecan (9 infusions)
Cost of pre-medication was removed	$32,266	$35,703	$29,307	$38,739
All costs other than the cost of EGFRi plus irinotecan were removed	$30,000	$31,850	$27,000	$32,350
All costs other than the cost of EGFRi were removed	$30,000	$30,150	$27,000	$30,820
Average patient body surface area of 1.5 m^2	$32,266	$32,531	$29,307	$33,700
Average patient body surface area of 1.9 m^2	$32,266	$39,431	$29,307	$40,245
Average patient body weight of 65 kg	$26,266	$36,081	$23,907	$39,910
Average patient body weight of 80 kg	$32,266	$36,081	$29,307	$39,910
Incorporation of ASPECCT adverse event rates	$32,297	$36,010	$29,337	$39,809
Range of incremental costs of Cetuximab plus Irinotecan	$150–$9815		$4393–$16,003

EGFRi, epidermal growth factor receptor inhibitor; mCRC, metastatic colorectal cancer; ASPECCT, Study of panitumumab vs cetuximab in patients with chemotherapy-refractory wild-type KRAS exon 2 metastatic colorectal cancer8.

Rapport Financier Annuel. Gouvernement du Québec, Ministère de la santé et des services sociaux. Formulaire AS-471. Quebec, Canada: Sante et Services sociaux Quebec; 2013

 Google Scholar

Price T, Peeters M, Kim TW, et al. Panitumumab versus cetuximab in patients with chemotherapy-refractory wild-type KRAS exon 2 metastatic colorectal cancer (ASPECCT): a randomised, multicentre, open-label, non-inferiority phase 3 study. Lancet Oncol 2014;15:569-79

 PubMed Web of Science ®Google Scholar