Cost-Effectiveness Analysis of First-Line FOLFIRI Combined With Cetuximab or Bevacizumab in Patients With RAS Wild-Type Left-Sided Metastatic Colorectal Cancer
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)...
| Main Authors: | , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2020-02-01
|
| Series: | Cancer Control |
| Online Access: | https://doi.org/10.1177/1073274820902271 |
| _version_ | 1797772247513956352 |
|---|---|
| author | Jiaqi Han MD Desheng Xiao PhD Chongqing Tan PhD Xiaohui Zeng MD Huabin Hu MD Shan Zeng PhD, MD Qin Jiang MD Longjiang She MD Linli Yao MD Li Li MD Lanhua Tang PhD Jian Ma PhD, MD Jin Huang PhD, MD Liangfang Shen PhD, MD |
| author_facet | Jiaqi Han MD Desheng Xiao PhD Chongqing Tan PhD Xiaohui Zeng MD Huabin Hu MD Shan Zeng PhD, MD Qin Jiang MD Longjiang She MD Linli Yao MD Li Li MD Lanhua Tang PhD Jian Ma PhD, MD Jin Huang PhD, MD Liangfang Shen PhD, MD |
| author_sort | Jiaqi Han MD |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-12T21:48:21Z |
| format | Article |
| id | doaj.art-86f087976bbc451ea2f0a58444abe768 |
| institution | Directory Open Access Journal |
| issn | 1073-2748 |
| language | English |
| last_indexed | 2024-03-12T21:48:21Z |
| publishDate | 2020-02-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Cancer Control |
| spelling | doaj.art-86f087976bbc451ea2f0a58444abe7682023-07-26T07:07:23ZengSAGE PublishingCancer Control1073-27482020-02-012710.1177/1073274820902271Cost-Effectiveness Analysis of First-Line FOLFIRI Combined With Cetuximab or Bevacizumab in Patients With RAS Wild-Type Left-Sided Metastatic Colorectal CancerJiaqi Han MD0Desheng Xiao PhD1Chongqing Tan PhD2Xiaohui Zeng MD3Huabin Hu MD4Shan Zeng PhD, MD5Qin Jiang MD6Longjiang She MD7Linli Yao MD8Li Li MD9Lanhua Tang PhD10Jian Ma PhD, MD11Jin Huang PhD, MD12Liangfang Shen PhD, MD13 Department of Oncology, Xiangya Hospital, Central South University, Changsha, China Department of Pathology, Xiangya Hospital, Central South University, Changsha, China Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China PET-CT Center, The Second Xiangya Hospital of Central South University, Changsha, China Department of Medical Oncology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China Department of Oncology, Xiangya Hospital, Central South University, Changsha, China Department of Oncology, Xiangya Hospital, Central South University, Changsha, China Department of Oncology, Xiangya Hospital, Central South University, Changsha, China Department of Oncology, Xiangya Hospital, Central South University, Changsha, China Department of Oncology, Xiangya Hospital, Central South University, Changsha, China Department of Oncology, Xiangya Hospital, Central South University, Changsha, China Cancer Research Institute, Hunan Key Laboratory of Nonresolving Inflammation and Cancer, Central South University, Changsha, China Department of Oncology, Xiangya Hospital, Central South University, Changsha, China Department of Oncology, Xiangya Hospital, Central South University, Changsha, ChinaBackground: 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.https://doi.org/10.1177/1073274820902271 |
| spellingShingle | Jiaqi Han MD Desheng Xiao PhD Chongqing Tan PhD Xiaohui Zeng MD Huabin Hu MD Shan Zeng PhD, MD Qin Jiang MD Longjiang She MD Linli Yao MD Li Li MD Lanhua Tang PhD Jian Ma PhD, MD Jin Huang PhD, MD Liangfang Shen PhD, MD Cost-Effectiveness Analysis of First-Line FOLFIRI Combined With Cetuximab or Bevacizumab in Patients With RAS Wild-Type Left-Sided Metastatic Colorectal Cancer Cancer Control |
| title | Cost-Effectiveness Analysis of First-Line FOLFIRI Combined With Cetuximab or Bevacizumab in Patients With RAS Wild-Type Left-Sided Metastatic Colorectal Cancer |
| title_full | Cost-Effectiveness Analysis of First-Line FOLFIRI Combined With Cetuximab or Bevacizumab in Patients With RAS Wild-Type Left-Sided Metastatic Colorectal Cancer |
| title_fullStr | Cost-Effectiveness Analysis of First-Line FOLFIRI Combined With Cetuximab or Bevacizumab in Patients With RAS Wild-Type Left-Sided Metastatic Colorectal Cancer |
| title_full_unstemmed | Cost-Effectiveness Analysis of First-Line FOLFIRI Combined With Cetuximab or Bevacizumab in Patients With RAS Wild-Type Left-Sided Metastatic Colorectal Cancer |
| title_short | Cost-Effectiveness Analysis of First-Line FOLFIRI Combined With Cetuximab or Bevacizumab in Patients With RAS Wild-Type Left-Sided Metastatic Colorectal Cancer |
| title_sort | cost effectiveness analysis of first line folfiri combined with cetuximab or bevacizumab in patients with ras wild type left sided metastatic colorectal cancer |
| url | https://doi.org/10.1177/1073274820902271 |
| work_keys_str_mv | AT jiaqihanmd costeffectivenessanalysisoffirstlinefolfiricombinedwithcetuximaborbevacizumabinpatientswithraswildtypeleftsidedmetastaticcolorectalcancer AT deshengxiaophd costeffectivenessanalysisoffirstlinefolfiricombinedwithcetuximaborbevacizumabinpatientswithraswildtypeleftsidedmetastaticcolorectalcancer AT chongqingtanphd costeffectivenessanalysisoffirstlinefolfiricombinedwithcetuximaborbevacizumabinpatientswithraswildtypeleftsidedmetastaticcolorectalcancer AT xiaohuizengmd costeffectivenessanalysisoffirstlinefolfiricombinedwithcetuximaborbevacizumabinpatientswithraswildtypeleftsidedmetastaticcolorectalcancer AT huabinhumd costeffectivenessanalysisoffirstlinefolfiricombinedwithcetuximaborbevacizumabinpatientswithraswildtypeleftsidedmetastaticcolorectalcancer AT shanzengphdmd costeffectivenessanalysisoffirstlinefolfiricombinedwithcetuximaborbevacizumabinpatientswithraswildtypeleftsidedmetastaticcolorectalcancer AT qinjiangmd costeffectivenessanalysisoffirstlinefolfiricombinedwithcetuximaborbevacizumabinpatientswithraswildtypeleftsidedmetastaticcolorectalcancer AT longjiangshemd costeffectivenessanalysisoffirstlinefolfiricombinedwithcetuximaborbevacizumabinpatientswithraswildtypeleftsidedmetastaticcolorectalcancer AT linliyaomd costeffectivenessanalysisoffirstlinefolfiricombinedwithcetuximaborbevacizumabinpatientswithraswildtypeleftsidedmetastaticcolorectalcancer AT lilimd costeffectivenessanalysisoffirstlinefolfiricombinedwithcetuximaborbevacizumabinpatientswithraswildtypeleftsidedmetastaticcolorectalcancer AT lanhuatangphd costeffectivenessanalysisoffirstlinefolfiricombinedwithcetuximaborbevacizumabinpatientswithraswildtypeleftsidedmetastaticcolorectalcancer AT jianmaphdmd costeffectivenessanalysisoffirstlinefolfiricombinedwithcetuximaborbevacizumabinpatientswithraswildtypeleftsidedmetastaticcolorectalcancer AT jinhuangphdmd costeffectivenessanalysisoffirstlinefolfiricombinedwithcetuximaborbevacizumabinpatientswithraswildtypeleftsidedmetastaticcolorectalcancer AT liangfangshenphdmd costeffectivenessanalysisoffirstlinefolfiricombinedwithcetuximaborbevacizumabinpatientswithraswildtypeleftsidedmetastaticcolorectalcancer |