Cost-effectiveness analysis of regorafenib for metastatic colorectal cancer.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 658-658
Author(s):  
Daniel A. Goldstein ◽  
Bilal B. Ahmad ◽  
Qiushi Chen ◽  
Turgay Ayer ◽  
David H. Howard ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Best Supportive Care ◽  
Sensitivity Analyses ◽  
Correct Trial ◽  
The Third ◽  
Effectiveness Analysis ◽  
Life Years ◽  
Third Line ◽  
The Cost ◽  
Third Line Treatment

658 Background: Regorafenib was approved by the FDA in 2012 for the management of previously treated metastatic colorectal cancer (mCRC). It is now the standard of care in the third-line setting. Compared to placebo it improves median overall survival by 1.4 months but is associated with adverse effects and additional cost. The objective of this study was to examine the cost-effectiveness of regorafenib compared to best supportive care for patients receiving third-line treatment for mCRC. Methods: We developed a Markov model to compare the cost and effectiveness of regorafenib compared to best supportive care in the third-line treatment of mCRC based on randomized data from the CORRECT trial. Weibull models were fitted to the published overall and progression-free survival curves, and were used to extrapolate the cause-specific mortality and progression risks. Costs for administration and management of adverse events were based on Medicare reimbursement rates for hospital and physician services, and drug costs based on the Medicare average wholesale prices (all in 2014 US $). Health outcomes were measured in life years (LYs) and quality-adjusted life years (QALYs). Quality of life adjustments were calculated based on health utility values in the CORRECT trial and toxicity disutilities and durations were included for the most common toxicities: hand/foot syndrome, diarrhea, and hypertension. Model robustness was addressed by univariate and probabilistic sensitivity analyses (PSA). Results: In the model, regorafenib provided an additional 0.06 QALYs (0.12 LYs) at a cost of $40,373. The incremental cost-effectiveness ratio (ICER) was $734,153/QALY. In all one-way sensitivity analyses, the ICER of regorafenib was >$550,000/QALY. The ICER of regorafenib was greater than $200,000/QALY in >99% of PSAs. Conclusions: This is the first U.S.-based cost-effectiveness analysis of regorafenib in mCRC, and our findings show that regorafenib provides minimal incremental benefit at high incremental cost per QALY. The ICER of regorafenib could be improved by use of an effective biomarker to select patients most likely to benefit, or by a lower price for payers.

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

2020 ◽  
Vol 106 (5) ◽  
pp. 400-405 ◽  
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.

scholarly journals Cost-Effectiveness Analysis of Regorafenib for Metastatic Colorectal Cancer

2015 ◽  
Vol 33 (32) ◽  
pp. 3727-3732 ◽  
Author(s):  
Daniel A. Goldstein ◽  
Bilal B. Ahmad ◽  
Qiushi Chen ◽  
Turgay Ayer ◽  
David H. Howard ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Metastatic Colorectal Cancer ◽  
Sensitivity Analyses ◽  
Cost Effectiveness Ratio ◽  
The Third ◽  
Life Years ◽  
Third Line ◽  
The Cost

Purpose Regorafenib is a standard-care option for treatment-refractory metastatic colorectal cancer that increases median overall survival by 6 weeks compared with placebo. Given this small incremental clinical benefit, we evaluated the cost-effectiveness of regorafenib in the third-line setting for patients with metastatic colorectal cancer from the US payer perspective. Methods We developed a Markov model to compare the cost and effectiveness of regorafenib with those of placebo in the third-line treatment of metastatic colorectal cancer. Health outcomes were measured in life-years and quality-adjusted life-years (QALYs). Drug costs were based on Medicare reimbursement rates in 2014. Model robustness was addressed in univariable and probabilistic sensitivity analyses. Results Regorafenib provided an additional 0.04 QALYs (0.13 life-years) at a cost of $40,000, resulting in an incremental cost-effectiveness ratio of $900,000 per QALY. The incremental cost-effectiveness ratio for regorafenib was > $550,000 per QALY in all of our univariable and probabilistic sensitivity analyses. Conclusion Regorafenib provides minimal incremental benefit at high incremental cost per QALY in the third-line management of metastatic colorectal cancer. The cost-effectiveness of regorafenib could be improved by the use of value-based pricing.

scholarly journals Cost Effectiveness Analysis of Eribulin Mesylate as a Treatment for Metastatic Breast Cancer in Spain: Management in the Later Line of Therapy

10.36469/9834 ◽  
2015 ◽  
Vol 3 (2) ◽  
pp. 180-193
Author(s):  
Gabriel Tremblay ◽  
Unnati Majethia ◽  
Ilias Kontoudis ◽  
Jesús De Rosendo
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Cost Effectiveness ◽  
Metastatic Breast ◽  
Sensitivity Analyses ◽  
Line Treatment ◽  
Second Line ◽  
Life Years ◽  
Third Line ◽  
Third Line Treatment

Background: Two thirds (62%) of metastatic breast cancer (MBC) patients in Western Europe have human epidermal growth factor receptor 2 (HER2)-negative disease, for which anthracyclines and taxanes are recommended as first-line treatments, followed by microtubule-targeting agents such as capecitabine, vinorelbine and/or eribulin. The study objective was to compare the cost-effectiveness of eribulin in Spain as a second-line treatment for HER2-negative MBC with its current status as a third-line treatment for patients who have received capecitabine. Methods: A Markov model was developed from the perspective of the Spanish healthcare system. The model had three health states: Stable; Progression and Death. In Stable, patients received eribulin or: capecitabine and vinorelbine for HER2-negative patients; primary treatment of physician’s choice (TPC) for post-capecitabine patients. In Progression, all patients received secondary TPC. Model inputs were overall survival, progression-free survival and costs relating to chemotherapies, grade 3/4 adverse events and healthcare utilization. Sensitivity analyses were conducted to identify uncertainty. Results: As second-line treatment, Eribulin was associated with a greater incremental benefit in life years (LYs) and quality-adjusted life years (QALYs) than capecitabine and vinorelbine. Erubilin as third-line treatment was associated with greater benefit in life years (LYs) and QALYs than TPC. The incremental cost-effectiveness ratios (ICERs) for eribulin were higher in the second-line than the third-line setting in terms of LYs (€35,149 versus €24,884) and QALYs (€37,152 versus €35,484). In both settings, deterministic sensitivity analyses demonstrated that the ICER is most sensitive to the eribulin price. Conclusion: Eribulin is cost-effective as second-line treatment for HER2-negative MBC patients in Spain; albeit, slightly less so than as third-line treatment for MBC patients who have received capecitabine (an ICER per QALY difference of €1,668). This difference may fall within the margin of error for the model and could potentially be addressed by a minor reduction in the eribulin price.

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

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.

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

BMC Cancer ◽  
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.

Cost-effectiveness for metastatic colorectal cancer.

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.

Erlotinib or best supportive care for third-line treatment of advanced non-small-cell lung cancer: A real-world cost-effectiveness analysis

Lung Cancer ◽  
2012 ◽  
Vol 76 (3) ◽  
pp. 472-477 ◽  
Author(s):  
Ian Cromwell ◽  
Kimberly van der Hoek ◽  
Suzanne C. Malfair Taylor ◽  
Barbara Melosky ◽  
Stuart Peacock
Keyword(s):  
Lung Cancer ◽  
Cost Effectiveness ◽  
Supportive Care ◽  
Best Supportive Care ◽  
Small Cell ◽  
Line Treatment ◽  
Small Cell Lung ◽  
Effectiveness Analysis ◽  
Third Line ◽  
Third Line Treatment
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