Cost-effectiveness of TAS-102 plus bevacizumab versus TAS-102 monotherapy in patients with metastatic colorectal cancer

Abstract Background TAS-102 plus bevacizumab is an anticipated combination regimen for patients who have metastatic colorectal cancer. However, evidence supporting its use for this indication is limited. We compared the cost-effectiveness of TAS-102 plus bevacizumab combination therapy with TAS-102 monotherapy for patients with chemorefractory metastatic colorectal cancer. Method Markov decision modeling using treatment costs, disease-free survival, and overall survival was performed to examine the cost-effectiveness of TAS-102 plus bevacizumab combination therapy and TAS-102 monotherapy. The Japanese health care payer’s perspective was adopted. The outcomes were modeled on the basis of published literature. The incremental cost-effectiveness ratio (ICER) between the two treatment regimens was the primary outcome. Sensitivity analysis was performed and the effect of uncertainty on the model parameters were investigated. Results TAS-102 plus bevacizumab had an ICER of $21,534 per quality-adjusted life-year (QALY) gained compared with TAS-102 monotherapy. Sensitivity analysis demonstrated that TAS-102 monotherapy was more cost-effective than TAS-102 and bevacizumab combination therapy at a willingness-to-pay of under $50,000 per QALY gained. Conclusions TAS-102 and bevacizumab combination therapy is a cost-effective option for patients who have metastatic colorectal cancer in the Japanese health care system.

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Cost-Effectiveness of UGT1A1*28 Genotyping in Preventing Severe Neutropenia Following FOLFIRI Therapy in Colorectal Cancer.

Journal of Pharmacy & Pharmaceutical Sciences ◽

10.18433/j3wk5s ◽

2011 ◽

Vol 13 (4) ◽

pp. 615 ◽

Cited By ~ 22

Author(s):

Solen Pichereau ◽

Anne Le Louarn ◽

Thierry Lecomte ◽

Hélène Blasco ◽

Chantal Le Guellec ◽

...

Keyword(s):

Colorectal Cancer ◽

Sensitivity Analysis ◽

Cost Effectiveness ◽

Febrile Neutropenia ◽

Metastatic Colorectal Cancer ◽

Severe Neutropenia ◽

Functional Polymorphisms ◽

The Cost ◽

Genotype Screening ◽

Ugt1a1 Genotype

PURPOSE: Functional polymorphisms of the UGT1A1 gene, particularly the UGT1A1*28 variant, are associated with the severity of the bone marrow suppression in patients with metastatic colorectal cancer receiving irinotecan. This study assesses the cost-effectiveness of screening for UGT1A1*28 polymorphism associated with primary prophylactic Granulocytes Colony Stimulating Factor in patients homozygous for the *28 allele. The effectiveness was estimated based on the number of neutropenia avoided. METHODS: We modelled a theoretical population treated with combined 5-fluorouracil, leucovorin and irinotecan (FOLFIRI) for metastatic colorectal cancer. A decision tree simulated the health outcomes, measured by the prevalence of neutropenic events for two strategies, with or without UGT1A1 genotype screening. The model incorporated direct hospital costs and was validated with a sensitivity analysis. We calculated the cost-effectiveness ratio: CE=∆C / ∆E = "genotyping" cost – "no genotyping" cost / number of febrile neutropenia avoided. RESULTS: In the "genotyping strategy", the cost to avoid one febrile neutropenia event per 1000 patients treated was € 942.8 to € 1090.1. The sensitivity analysis showed a better CE ratio of € 733.4 to € 726.6 per febrile neutropenic event avoided.CONCLUSIONS: UGT1A1 genotype screening before irinotecan treatment is a cost-efficient strategy for the hospital. Systematic genotyping prior to chemotherapy, and administration of CSF in patients homozygotes for the *28 allele allow to avoid 91 febrile neutropenias at an acceptable cost.

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Cost-effectiveness analysis of fruquintinib for metastatic colorectal cancer third-line treatment in China

10.21203/rs.3.rs-16001/v3 ◽

2020 ◽

Author(s):

Zhi Peng ◽

Xingduo Hou ◽

Yangmu Huang ◽

Tong Xie ◽

Xinyang Hua

Keyword(s):

Colorectal Cancer ◽

Cost Effectiveness ◽

Metastatic Colorectal Cancer ◽

Cost Effective ◽

Line Treatment ◽

Lifetime Horizon ◽

Life Years ◽

Third Line ◽

The Cost ◽

Third Line Treatment

Abstract Background: In this study, we analyze the cost-effectiveness of fruquintinib as third-line treatment for patients with metastatic colorectal cancer in China, especially after a recent price drop suggested by the National Healthcare Security Administration. Methods: A Markov model was developed to investigate the cost-effectiveness of fruquintinib compared to placebo among patients with metastatic colorectal cancer. Effectiveness was measured in quality-adjusted life years (QALY). The Chinese healthcare payer’s perspective was considered with a lifetime horizon, including direct medical cost (2019 US dollars [USD]). A willing‐to‐pay threshold was set at USD 27,130/QALY, which is three times the gross domestic product (GDP) per capita. We examined the robustness of the model in one-way and probabilistic sensitivity analysis.Results: Fruquintinib was associated with better health outcomes than placebo (0.640 vs 0.478 QALYs) with a higher cost (USD 20750.9 vs USD 12042.2), resulting in an incremental cost-effectiveness ratio (ICER) of USD 53508.7 per QALY. This ICER is 25% lower than the one calculated before the price drop (USD 70952.6 per QALY).Conclusion: After the price negotiation, the drug becomes cheaper and the ICER is lower, but the drug is still not cost effective under the standard of 3 times GDP willing‐to‐pay threshold. For patients with metastatic colorectal cancer in China, fruquintinib is not a cost-effective option under the current circumstances in China.

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Cost-effectiveness analysis of fruquintinib for metastatic colorectal cancer third-line treatment in China

10.21203/rs.3.rs-16001/v1 ◽

2020 ◽

Author(s):

Zhi Peng ◽

Xingduo Hou ◽

Yangmu Huang ◽

Tong Xie ◽

Xinyang Hua

Keyword(s):

Colorectal Cancer ◽

Cost Effectiveness ◽

Metastatic Colorectal Cancer ◽

Cost Effective ◽

Quality Adjusted Life Year ◽

Line Treatment ◽

Lifetime Horizon ◽

Third Line ◽

The Cost ◽

Third Line Treatment

Abstract Background : In this study, we analyze the cost-effectiveness of fruquintinib as third-line treatment for patients with metastatic colorectal cancer in China, especially after a recent price drop suggested by the National Healthcare Security Administration. Methods : A Markov model was developed to investigate the cost-effectiveness of fruquintinib compared to placebo among patients with metastatic colorectal cancer. Effectiveness was measured in quality-adjusted life year (QALY). The Chinese healthcare payer’s perspective was considered with a lifetime horizon, including direct medical cost (2019 US dollars [USD]). A willing‐to‐pay threshold was set USD 27,130/QALY, which is 3 times gross domestic product (GDP) per capita. We examined the robustness of the model in one-way and probabilistic sensitivity analysis. Results : Fruquintinib was associated with better health outcomes than placebo (0.640 vs 0.478 QALYs) with a higher cost (USD 20750.9 vs USD 12042.2), resulting an incremental results effectiveness ratio (ICER) of USD 53508.7 per QALY. This ICER is 25% lower than the one calculated before the price drop (USD 70952.6 per QALY). Conclusion : After the price negotiation, the drug becomes cheaper and the ICER is lower, but the drug is still not cost effective under the standard of 3 times GDP willing‐to‐pay threshold. For patients with metastatic colorectal cancer in China, fruquintinib is not a cost-effective option under the current circumstances in China.

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Cost-effectiveness analysis of fruquintinib for metastatic colorectal cancer third-line treatment in China

BMC Cancer ◽

10.1186/s12885-020-07486-w ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Zhi Peng ◽

Xingduo Hou ◽

Yangmu Huang ◽

Tong Xie ◽

Xinyang Hua

Keyword(s):

Colorectal Cancer ◽

Cost Effectiveness ◽

Metastatic Colorectal Cancer ◽

Cost Effective ◽

Line Treatment ◽

Lifetime Horizon ◽

Life Years ◽

Third Line ◽

The Cost ◽

Third Line Treatment

Abstract Background In this study, we analyze the cost-effectiveness of fruquintinib as third-line treatment for patients with metastatic colorectal cancer in China, especially after a recent price drop suggested by the National Healthcare Security Administration. Methods A Markov model was developed to investigate the cost-effectiveness of fruquintinib compared to placebo among patients with metastatic colorectal cancer. Effectiveness was measured in quality-adjusted life years (QALY). The Chinese healthcare payer’s perspective was considered with a lifetime horizon, including direct medical cost (2019 US dollars [USD]). A willing-to-pay threshold was set at USD 27,130/QALY, which is three times the gross domestic product (GDP) per capita. We examined the robustness of the model in one-way and probabilistic sensitivity analysis. Results Fruquintinib was associated with better health outcomes than placebo (0.640 vs 0.478 QALYs) with a higher cost (USD 20750.9 vs USD 12042.2), resulting in an incremental cost-effectiveness ratio (ICER) of USD 53508.7 per QALY. This ICER is 25% lower than the one calculated before the price drop (USD 70952.6 per QALY). Conclusion After the price negotiation, the drug becomes cheaper and the ICER is lower, but the drug is still not cost effective under the standard of 3 times GDP willing-to-pay threshold. For patients with metastatic colorectal cancer in China, fruquintinib is not a cost-effective option under the current circumstances in China.

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Cost-effectiveness for metastatic colorectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e15003 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e15003-e15003

Author(s):

Linli Yao ◽

Jiaqi Han ◽

Longjiang She ◽

Dong Ding ◽

Mengting Liao ◽

...

Keyword(s):

Colorectal Cancer ◽

Cost Effectiveness ◽

Metastatic Colorectal Cancer ◽

Cost Effective ◽

The Third ◽

Scenario Analyses ◽

Payer Perspective ◽

Life Years ◽

Third Line ◽

The Cost

e15003 Background: As standard third-line treatments for metastatic colorectal cancer, regorafenib and fruquintinib, compared with placebo, increase median overall survival by 2.5 months and 2.7 months, respectively. Given the incremental clinical benefit, we aim to estimate the cost effectiveness of regorafenib versus fruquintinib in the third-line treatment for patients with metastatic colorectal cancer from Chinese payer perspective. Methods: A mathematical Markov model was established to project the cost-effectiveness of regorafenib versus fruquintinib from the CONCUR and FRESCO clinical trials. Quality-adjusted-life-years (QALYs) were analyzed with extracted data from the trials. Willingness to pay (WTP) of $26508 was used. Drug costs were estimated from the perspectives of the health care system in the People’s Republic of China. One way sensitivity and scenario analyses were performed by varying potentially modifiable parameters of the model. Results: Fruquintinib, compared with regorafenib, provided an additional 0.028 QALYs (0.274 QALYs versus 0.246 QALYs) at less cost ($33536 versus $35607). Conclusions: Fruquintinib is more cost-effective than regorafenib as the third-line management for patients with metastatic colorectal cancer when WTP is $26508.

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Cost-effectiveness analysis of fruquintinib as third-line treatment for patients with metastatic colorectal cancer

Tumori Journal ◽

10.1177/0300891620916789 ◽

2020 ◽

Vol 106 (5) ◽

pp. 400-405 ◽

Cited By ~ 1

Author(s):

Peng-Fei Zhang ◽

Dan Xie ◽

Qiu Li

Keyword(s):

Colorectal Cancer ◽

Cost Effectiveness ◽

Metastatic Colorectal Cancer ◽

Cost Effective ◽

Sensitivity Analyses ◽

Line Treatment ◽

Effectiveness Analysis ◽

Third Line ◽

The Cost ◽

Third Line Treatment

Objective: To evaluate the cost-effectiveness of addition of fruquintinib to best supportive care (BSC) in third-line treatment for patients with metastatic colorectal cancer (CRC). Methods: To conduct the cost-effectiveness analysis, a Markov model was established to simulate the course of metastatic CRC. Three health states—progression-free survival (PFS), progressive disease (PD), and death—were included. Clinical data were derived from the FRESCO trial and health utility values were extracted from previous literature. The primary outcome of the study was incremental cost-effectiveness ratio (ICER) in US dollars per quality-adjusted life-years (QALYs) from a Chinese societal perspective. One-way sensitivity analyses and probabilistic sensitivity analyses were performed to test the robustness of the study. Results: Addition of fruquintinib to BSC gained 0.54 QALY at a cost of $15,404.57 while the BSC group gained 0.38 QALY at a cost of $9603.94. ICER of fruquintinib versus BSC was $36,253.94/QALY. In the 1-way sensitivity analyses, utility for PD in both groups, utility for PFS in both groups, and cost of fruquintinib significantly influenced the results of the analysis. At the willingness-to-pay threshold of $28,988.40/QALY, probabilities of addition of fruquintinib to BSC or BSC alone as the cost-effective option were 0% and 100%, indicating addition of fruquintinib is not a dominant option compared with BSC. Conclusions: Addition of fruquintinib to BSC is not a cost-effective regimen in the third-line setting for patients with metastatic CRC from the Chinese societal perspective.

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Fruquintinib or regorafenib as the third-line treatments for metastatic colorectal cancer based on CONCUR and FRESCO trials: A cost-effectiveness analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e15011 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e15011-e15011

Author(s):

Qiu Li ◽

Mengxi Zhang

Keyword(s):

Colorectal Cancer ◽

Sensitivity Analysis ◽

Cost Effectiveness ◽

Metastatic Colorectal Cancer ◽

Cost Effective ◽

Two Phase ◽

The Third ◽

Life Years ◽

Third Line ◽

The Impact

e15011 Background: Survival benefit of regorafenib and fruquintinib as third-line agents have been respectively demonstrated in patients with treatment-refractory metastatic colorectal cancer. This study tries to explore the cost-effectiveness of the two agents. Methods: A Markov model was performed based on two phase 3 trials, FRESCO and CONCUR. Health outcomes were measured with quality-adjusted life-years (QALYs). The key outcome was incremental cost-effectiveness ratio (ICER). Probabilistic sensitivity and one-way sensitivity analysis were performed to estimate the impact of essential variables on the results of the analysis. Results: No statistical differences were observed in the baseline patient characteristics, except that the CONCUR trial enrolled older patients and higher ratios of prior use of VEGF or EGFR antibodies in comparison with the FRESCO trial.Treatment with fruquintinib was estimated to cost $25,550.15 with an effectiveness gain of 0.54 QALYs, whereas regorafenib resulted in 0.53 QALY at a mean cost of $29,681.52, yielding ICER of $-413,137.00 per QALY. By using treble the Chinese Gross Domestic Product per Capita as willingness-to-pay threshold, the probability for fruquintinib being cost-effective was higher than regorafenib in the probabilistic sensitivity analysis. Conclusions: Fruquintinib provides a more cost-effective option for metastatic colorectal patients compared with regorafenib in the third line treatment.[Table: see text]

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Real-World Cost-Effectiveness Analysis of Gemcitabine and Cisplatin Compared to Docetaxel and Cisplatin Plus Fluorouracil Induction Chemotherapy in Locoregionally Advanced Nasopharyngeal Carcinoma

Frontiers in Oncology ◽

10.3389/fonc.2020.594756 ◽

2020 ◽

Vol 10 ◽

Author(s):

Jiangping Yang ◽

Jiaqi Han ◽

Jinlan He ◽

Baofeng Duan ◽

Qiheng Gou ◽

...

Keyword(s):

Sensitivity Analysis ◽

Cost Effectiveness ◽

Nasopharyngeal Carcinoma ◽

Incremental Cost ◽

Real World ◽

Cost Effective ◽

Model Parameters ◽

The Cost ◽

The Impact ◽

Gemcitabine And Cisplatin

BackgroundAddition of gemcitabine and cisplatin (GP) or docetaxel and cisplatin plus fluorouracil (TPF) to concurrent chemoradiotherapy (CCRT) signiﬁcantly improved survival in locoregionally advanced nasopharyngeal carcinoma (NPC). However, an economic evaluation of these regimens remains unknown. The purpose of this study is to compare the cost-effectiveness of GP versus TPF regimen in the treatment of locoregionally advanced NPC in China.Materials and methodsA comprehensive Markov model was developed to evaluate the health and economic outcomes of GP versus TPF regimen for patients with locoregionally advanced NPC. Baseline and clinical outcome were derived from 158 patients with newly diagnosed stage III-IVA NPC between 2010 and 2015. We evaluated the quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs) from the perspective of the Chinese healthcare system. One-way sensitive analysis explored the impact of uncertainty in key model parameters on results, and probabilistic uncertainty was assessed through a Monte Carlo probabilistic sensitivity analysis.ResultsGP regimen provided an additional 0.42 QALYs with incremental cost of $3,821.99, resulting in an ICER of $9,099.98 per QALY versus TPF regimen at the real-world setting. One-way sensitivity analysis found that the results were most sensitive to the cost and proportion of receiving subsequent treatment in two groups. The probability that GP regimen being cost-effective compared with TPF regimen was 86.9% at a willingness-to-pay (WTP) of $31,008.16 per QALY.ConclusionUsing real-world data, GP regimen was demonstrated a cost-effective alternative to TFP regimen for patients with locoregionally advanced NPC in China. It provides valuable evidence for clinicians when making treatment decisions to improve the cost-effectiveness of treatment.

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Cost-effectiveness analysis of fruquintinib for metastatic colorectal cancer third-line treatment in China

10.21203/rs.3.rs-16001/v2 ◽

2020 ◽

Author(s):

Zhi Peng ◽

Xingduo Hou ◽

Yangmu Huang ◽

Tong Xie ◽

Xinyang Hua

Keyword(s):

Colorectal Cancer ◽

Cost Effectiveness ◽

Metastatic Colorectal Cancer ◽

Cost Effective ◽

Line Treatment ◽

Lifetime Horizon ◽

Life Years ◽

Third Line ◽

The Cost ◽

Third Line Treatment

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Cost-effectiveness analysis of selective first-line use of biologics for unresectable RAS wild-type left-sided metastatic colorectal cancer

Current Oncology ◽

10.3747/co.26.4843 ◽

2019 ◽

Vol 26 (5) ◽

Author(s):

W. W.L. Wong ◽

M. Zargar ◽

S. R. Berry ◽

Y. J. Ko ◽

M. Riesco-Martínez ◽

...

Keyword(s):

Colorectal Cancer ◽

Cost Effectiveness ◽

Metastatic Colorectal Cancer ◽

Primary Tumour ◽

Cost Effective ◽

Standard Of Care ◽

Wild Type ◽

First Line ◽

Life Years ◽

The Cost

Background Evidence from a retrospective analysis of multiple large phase iii trials suggested that primary tumour location (ptl) in RAS wild-type metastatic colorectal cancer (wtRAS mcrc) might have predictive value with respect to response to drug therapies. Recent studies also show a potential preferential benefit for epidermal growth factor inhibitors (egfris) for left-sided tumours. In the present study, we aimed to determine the incremental costeffectiveness ratio (icer) for the first-line use of an egfri for patients with left-sided wtRAS mcrc.Methods We developed a state-transition model to determine the cost effectiveness of alternative treatmentstrategies in patients with left-sided mcrc:■ Standard of care■ Use of an egfri in first-line therapyThe cohort for the study consisted of patients diagnosed with unresectable wtRAS mcrc with an indication for chemotherapy and previously documented ptl. Model parameters were obtained from the published literature and calibration. The perspective was that of a provincial ministry of health in Canada. We used a 5-year time horizon and an annual discount rate of 1.5%.Results Selecting patients for first-line egfri treatment based on left-sided location of their colorectal primary tumour was more effective than the standard of care, resulting in an increase in quality-adjusted life-years (qalys) of 0.226 (or 0.644 life-years gained). However, the strategy was also more expensive, costing an average of $60,639 more per patient treated. The resulting icer was $268,094 per qaly. A 35% price reduction in the cost of egfri would be needed to make this strategy cost-effective at a willingness-to-pay threshold (wtp) of $100,000 per qaly.Conclusions Selective use of an egfri based on ptl was more cost-effective than unselected use of those agents; however, based on traditional wtp thresholds, it was still not cost-effective. While awaiting the elucidation of more precise predictive biomarkers that might improve cost-effectiveness, the price of egfris could be reduced to meet the wtp threshold.

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