Cost-Effectiveness Analysis of First-Line FOLFIRI Combined With Cetuximab or Bevacizumab in Patients With RAS Wild-Type Left-Sided Metastatic Colorectal Cancer

Abstract

Background: The FIRE-3 phase III clinical trial demonstrated the marked advantage of prolonging the median overall survival of patients with final RAS wild-type (WT) left-sided metastatic colorectal cancer (mCRC) by 38.3 months after treatment with irinotecan, fluorouracil, and leucovorin (FOLFIRI) plus cetuximab and by 28.0 months after treatment with FOLFIRI plus bevacizumab. However, the substantial cost increase and economic impact of using cetuximab imposes a considerable burden on patients and society. Methods: A Markov model based on the data collected in the FIRE-3 trial was developed to investigate the cost-effectiveness of treating patients with FOLFIRI plus either cetuximab or bevacizumab from the perspective of the Chinese health-care system. Costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated over a lifetime horizon. One-way and probabilistic sensitivity analyses were performed by varying potentially modifiable parameters. Results: In our analysis, the total treatment costs in the bevacizumab and cetuximab groups were $92 549.31 and $94 987.31, respectively, and the QALYs gained were 1.58 and 2.05. In the base-case analysis, compared with bevacizumab, left-sided RAS WT patients receiving cetuximab gained 0.47 more QALYs at an ICER of $5187.23/QALY ($3166.23/LY). The 1-way sensitivity analysis showed that the most influential parameter was the cost of cetuximab. Probabilistic sensitivity analysis indicated that the cost-effective probability of cetuximab group was 92.8% under the willingness-to-pay threshold of $24 081. Conclusions: Treatment with FOLFIRI plus cetuximab in Chinese patients with left-sided RAS WT mCRC may improve health outcomes and use financial resources more efficiently than FOLFIRI plus bevacizumab.

Cost-effectiveness analysis of pembrolizumab versus chemotherapy as the first-line treatment in patients with mismatch-repair-deficient (dMMR) or microsatellite- instability-high (MSI-H) advanced or metastatic colorectal cancer from a perspective of health care system in China

“…the proportion of VEGF/EGFR inhibitor used as 2nd line regimes also had a great effect on the outcomes. For this, some scholars [50,51] have found that treatment with bevacizumab in Chinese patients with mCRC is unlikely to use nancial resources e ciently. In terms of EGFR inhibitor (cetuximab), Wu, B. et al [52] and Wang, H. et al [53] have conducted cost-effective analyses based on the CRYSTAL trial [54] and the TAILOR trial [55] respectively, and found that cetuximab combined with FOLFOX or FOLFIRI was not a cost-effective treatment for the patients with RAS wild-type mCRC in China, unless PAP was available.…”

Cost‐effectiveness analysis of continuing bevacizumab plus chemotherapy versus chemotherapy alone after first progression of metastatic colorectal cancer

“…8,9 Several studies have been investigated to determine the cost-effectiveness of bevacizumab in combination with chemotherapy as first-line treatment for patients with mCRC from the perspective of the Chinese healthcare system. [14][15][16][17] Zhang et al found that bevacizumab plus capecitabine was not a cost-effective treatment option for elderly patients with previously untreated mCRC. 17 Wen et al reported that RAS screening before bevacizumab therapy seemed as the most costeffective strategy with the shortest QALYs, compared with cetuximab (a monoclonal antibody of epidermal growth factor receptor, anti-EGFR mAb).…”

“…14 Han et al reported that bevacizumab plus FOLFIRI was not more costeffective than cetuximab plus FOLFIRI in Chinese patients with left-sided RAS WT mCRC. 15 Lee et al reported that compared with bevacizumab, addition of anti-EGFR mAb to chemotherapy was more cost-effective in patients with pan-RAS wild-type (WT) and left-sided pan-RAS WT, especially in left-sided pan-RAS WT mCRC populations from the Chinese Hong Kong societal perspective. 16 ML18147 trail reported significant survival benefits of continuing bevacizumab plus chemotherapy after first progression in mCRC patients previously receiving bevacizumab plus first-line chemotherapy.…”

Cost-effectiveness of FOLFOX6+Bevacizumab Versus FOLFOX6+Cetuximab in Stage IV Colorectal Cancer Patients in Shiraz, Iran

“…Some others investigated the cost-effectiveness of various drug combinations used in the treatment of stage IV colorectal cancer (not the drug combinations examined in the present study). [33][34][35][36][37] However, there are few studies comparing the cost-effectiveness and cost-utility of the drug combinations studied in this research, one of which is the study of Shida et al (2018) who conducted an economic evaluation of first-line drug regimens based on mFOLFOX6, mFOLFOX6+Bevacizumab, mFOLFOX6+Cetuximab, and mFOLFOX6+Panitumumab from the perspective of the public medical care. They suggested that the rates of overall survival and post-progression survival were higher for the patients receiving mFOLFOX6+Cetuximab, but mFOL-FOX6+Pmab was the most cost-effective drug regimen in their study.…”