Cost-effectiveness analysis of cetuximab for the treatment of head and neck cancers in India
- 1Department of Radiation Oncology, Government Medical College and Hospital
- 2Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER)
Abstract
Background: Head and neck cancers (HNC) comprise 5% of all malignancies worldwide. Cetuximab is the first targeted therapy to demonstrate a significant survival benefit in patients with locally advanced HNC (LAHNC) and recurrent or metastatic HNC (R/MHNC). In view of this, we undertook this economic evaluation to ascertain the costs and health benefits associated with (i) the use of RT + CTX over RT alone for LAHNC patients who are ineligible for cisplatin-based chemoradiotherapy and (ii) CT + CTX over CT alone for R/MHNC patients from the perspective of Indian healthcare system.
Methods: A Markov model was constructed to assess the lifetime costs and health outcomes using cetuximab in combination with radiotherapy (RT + CTX) for treatment of cisplatin-ineligible LAHNC ( Analysis I ), and cetuximab in combination with platinum-based chemotherapy (CT + CTX) for treatment of R/MHNC patients in India ( Analysis II ). Using an abridged societal perspective lifetime costs and quality adjusted life years (QALYs) were evaluated, discounting future costs and consequences at 3% annually. For both the analyses, costs of original as well as biosimilar cetuximab were evaluated. The cost-effectiveness was assessed in terms of incremental cost effectiveness ratio (ICER) which was compared against a threshold of 1-time per capita gross domestic product (GDP) for India in 2024–25 (₹ 247,045; US$ 2,697).
Results: Adding biosimilar cetuximab to radiotherapy for cisplatin-ineligible LAHNC patients resulted in 2.73 (95% CI: 2.11–3.30) QALYs, while adding biosimilar cetuximab to platinum-based chemotherapy for R/MHNC resulted in 0.78 (95% CI: 0.61–0.96) QALYs over the modelled lifetime horizon. The incremental cost per QALY gained was found to be ₹ 501,320 with use of RT + CTX and ₹ 15,023,037 with use of CT + CTX. At the currently recommended willingness to pay (WTP) threshold, treatment with cetuximab is not a cost-effective treatment option for patients with LAHNC and R/MHNC patients respectively in India. A 50% reduction in the price of biosimilar would make it a cost-effective option for treatment of LAHNC in India.
Conclusion: Strategic purchasing of biosimilar cetuximab at reduced price can provide good value for money for treatment of patients with LAHNC.
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BibTeX
@article{gupta2026costeffectiveness,
title = {{Cost-effectiveness analysis of cetuximab for the treatment of head and neck cancers in India}},
author = {Nidhi Gupta and Jyoti Dixit and Gaurav Jyani and Shankar Prinja},
journal = {Frontiers in Pharmacology},
year = {2026},
month = oct,
doi = {10.3389/fphar.2026.1948615},
url = {https://www.frontiersin.org/articles/10.3389/fphar.2026.1948615/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Cost-effectiveness analysis of cetuximab for the treatment of head and neck cancers in India
AU - Nidhi Gupta
AU - Jyoti Dixit
AU - Gaurav Jyani
AU - Shankar Prinja
PY - 2026
DA - 2026/10/23
JO - Frontiers in Pharmacology
DO - 10.3389/fphar.2026.1948615
UR - https://www.frontiersin.org/articles/10.3389/fphar.2026.1948615/full
AB - Background: Head and neck cancers (HNC) comprise 5% of all malignancies worldwide. Cetuximab is the first targeted therapy to demonstrate a significant survival benefit in patients with locally advanced HNC (LAHNC) and recurrent or metastatic HNC (R/MHNC). In view of this, we undertook this economic evaluation to ascertain the costs and health benefits associated with (i) the use of RT + CTX over RT alone for LAHNC patients who are ineligible for cisplatin-based chemoradiotherapy and (ii) CT + CTX over CT alone for R/MHNC patients from the perspective of Indian healthcare system. Methods: A Markov model was constructed to assess the lifetime costs and health outcomes using cetuximab in combination with radiotherapy (RT + CTX) for treatment of cisplatin-ineligible LAHNC ( Analysis I ), and cetuximab in combination with platinum-based chemotherapy (CT + CTX) for treatment of R/MHNC patients in India ( Analysis II ). Using an abridged societal perspective lifetime costs and quality adjusted life years (QALYs) were evaluated, discounting future costs and consequences at 3% annually. For both the analyses, costs of original as well as biosimilar cetuximab were evaluated. The cost-effectiveness was assessed in terms of incremental cost effectiveness ratio (ICER) which was compared against a threshold of 1-time per capita gross domestic product (GDP) for India in 2024–25 (₹ 247,045; US$ 2,697). Results: Adding biosimilar cetuximab to radiotherapy for cisplatin-ineligible LAHNC patients resulted in 2.73 (95% CI: 2.11–3.30) QALYs, while adding biosimilar cetuximab to platinum-based chemotherapy for R/MHNC resulted in 0.78 (95% CI: 0.61–0.96) QALYs over the modelled lifetime horizon. The incremental cost per QALY gained was found to be ₹ 501,320 with use of RT + CTX and ₹ 15,023,037 with use of CT + CTX. At the currently recommended willingness to pay (WTP) threshold, treatment with cetuximab is not a cost-effective treatment option for patients with LAHNC and R/MHNC patients respectively in India. A 50% reduction in the price of biosimilar would make it a cost-effective option for treatment of LAHNC in India. Conclusion: Strategic purchasing of biosimilar cetuximab at reduced price can provide good value for money for treatment of patients with LAHNC.
SN - 1663-9812
ER -