Skip to main content
Top
Published in: BMC Cancer 1/2020

Open Access 01-12-2020 | Regorafenib | Research article

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

Authors: Zhi Peng, Xingduo Hou, Yangmu Huang, Tong Xie, Xinyang Hua

Published in: BMC Cancer | Issue 1/2020

Login to get access

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.
Literature
1.
go back to reference Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.CrossRef Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.CrossRef
2.
go back to reference Zhu J, Tan Z, Hollis-Hansen K, Zhang Y, Yu C, Li Y. Epidemiological trends in colorectal cancer in China: an ecological study. Dig Dis Sci. 2017;62(1):235–43.CrossRef Zhu J, Tan Z, Hollis-Hansen K, Zhang Y, Yu C, Li Y. Epidemiological trends in colorectal cancer in China: an ecological study. Dig Dis Sci. 2017;62(1):235–43.CrossRef
3.
go back to reference Arnold M, Sierra MS, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global patterns and trends in colorectal cancer incidence and mortality. Gut. 2017;66(4):683–91.CrossRef Arnold M, Sierra MS, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global patterns and trends in colorectal cancer incidence and mortality. Gut. 2017;66(4):683–91.CrossRef
4.
go back to reference Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, et al. Cancer statistics in China, 2015. CA Cancer J Clin. 2016;66(2):115–32.CrossRef Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, et al. Cancer statistics in China, 2015. CA Cancer J Clin. 2016;66(2):115–32.CrossRef
5.
go back to reference Ciardiello F, Normanno N, Martinelli E, Troiani T, Pisconti S, Cardone C, et al. Cetuximab continuation after first progression in metastatic colorectal cancer (CAPRI-GOIM): a randomized phase II trial of FOLFOX plus cetuximab versus FOLFOX. Ann Oncol. 2016;27(6):1055–61.CrossRef Ciardiello F, Normanno N, Martinelli E, Troiani T, Pisconti S, Cardone C, et al. Cetuximab continuation after first progression in metastatic colorectal cancer (CAPRI-GOIM): a randomized phase II trial of FOLFOX plus cetuximab versus FOLFOX. Ann Oncol. 2016;27(6):1055–61.CrossRef
6.
go back to reference Hurwitz HI, Tebbutt NC, Kabbinavar F, Giantonio BJ, Guan ZZ, Mitchell L, et al. Efficacy and safety of bevacizumab in metastatic colorectal cancer: pooled analysis from seven randomized controlled trials. Oncologist. 2013;18(9):1004–12.CrossRef Hurwitz HI, Tebbutt NC, Kabbinavar F, Giantonio BJ, Guan ZZ, Mitchell L, et al. Efficacy and safety of bevacizumab in metastatic colorectal cancer: pooled analysis from seven randomized controlled trials. Oncologist. 2013;18(9):1004–12.CrossRef
7.
go back to reference Heinemann V, von Weikersthal LF, Decker T, Kiani A, Vehling-Kaiser U, Al-Batran SE, et al. FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer (FIRE-3): a randomised, open-label, phase 3 trial. Lancet Oncol. 2014;15(10):1065–75.CrossRef Heinemann V, von Weikersthal LF, Decker T, Kiani A, Vehling-Kaiser U, Al-Batran SE, et al. FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer (FIRE-3): a randomised, open-label, phase 3 trial. Lancet Oncol. 2014;15(10):1065–75.CrossRef
8.
go back to reference Seymour MT, Maughan TS, Ledermann JA, Topham C, James R, Gwyther SJ, et al. Different strategies of sequential and combination chemotherapy for patients with poor prognosis advanced colorectal cancer (MRC FOCUS): a randomised controlled trial. Lancet. 2007;370(9582):143–52.CrossRef Seymour MT, Maughan TS, Ledermann JA, Topham C, James R, Gwyther SJ, et al. Different strategies of sequential and combination chemotherapy for patients with poor prognosis advanced colorectal cancer (MRC FOCUS): a randomised controlled trial. Lancet. 2007;370(9582):143–52.CrossRef
9.
go back to reference Van Cutsem E, Peeters M, Siena S, Humblet Y, Hendlisz A, Neyns B, et al. Open-label phase III trial of panitumumab plus best supportive care compared with best supportive care alone in patients with chemotherapy-refractory metastatic colorectal cancer. J Clin Oncol. 2007;25(13):1658–64.CrossRef Van Cutsem E, Peeters M, Siena S, Humblet Y, Hendlisz A, Neyns B, et al. Open-label phase III trial of panitumumab plus best supportive care compared with best supportive care alone in patients with chemotherapy-refractory metastatic colorectal cancer. J Clin Oncol. 2007;25(13):1658–64.CrossRef
10.
go back to reference Jonker DJ, O'Callaghan CJ, Karapetis CS, Zalcberg JR, Tu D, Au HJ, Berry SR, Krahn M, Price T, Simes RJ, Tebbutt NC, et al. Cetuximab for the treatment of colorectal cancer. N Engl J Med. 2007;357(20):2040-8. https://doi.org/10.1056/NEJMoa071834. PMID: 18003960. Jonker DJ, O'Callaghan CJ, Karapetis CS, Zalcberg JR, Tu D, Au HJ, Berry SR, Krahn M, Price T, Simes RJ, Tebbutt NC, et al. Cetuximab for the treatment of colorectal cancer. N Engl J Med. 2007;357(20):2040-8. https://​doi.​org/​10.​1056/​NEJMoa071834. PMID: 18003960.
11.
go back to reference Bekaii-Saab T, Kim R, Kim TW, O'Connor JM, Strickler JH, Malka D, et al. Third- or later-line therapy for metastatic colorectal cancer: reviewing best practice. Clin Colorectal Cancer. 2019;18(1):e117–e29.CrossRef Bekaii-Saab T, Kim R, Kim TW, O'Connor JM, Strickler JH, Malka D, et al. Third- or later-line therapy for metastatic colorectal cancer: reviewing best practice. Clin Colorectal Cancer. 2019;18(1):e117–e29.CrossRef
12.
go back to reference Zhang Q, Wang Q, Wang X, Li J, Shen L, Peng Z. Regorafenib, TAS-102, or fruquintinib for metastatic colorectal cancer: any difference in randomized trials?[J]. Int J Color Dis. 2019;35(2):295–306.CrossRef Zhang Q, Wang Q, Wang X, Li J, Shen L, Peng Z. Regorafenib, TAS-102, or fruquintinib for metastatic colorectal cancer: any difference in randomized trials?[J]. Int J Color Dis. 2019;35(2):295–306.CrossRef
13.
go back to reference Li J, Qin S, Xu RH, Shen L, Xu J, Bai Y, et al. Effect of fruquintinib vs placebo on overall survival in patients with previously treated metastatic colorectal cancer: the FRESCO randomized clinical trial. JAMA. 2018;319(24):2486–96.CrossRef Li J, Qin S, Xu RH, Shen L, Xu J, Bai Y, et al. Effect of fruquintinib vs placebo on overall survival in patients with previously treated metastatic colorectal cancer: the FRESCO randomized clinical trial. JAMA. 2018;319(24):2486–96.CrossRef
14.
go back to reference Goldstein DA, Ahmad BB, Chen Q, et al. Cost-effectiveness analysis of regorafenib for metastatic colorectal cancer.[J]. J Clin Oncol. 2011;33(32):3727–32.CrossRef Goldstein DA, Ahmad BB, Chen Q, et al. Cost-effectiveness analysis of regorafenib for metastatic colorectal cancer.[J]. J Clin Oncol. 2011;33(32):3727–32.CrossRef
17.
go back to reference Chong-Qing T. Build pharmacoeconomics evaluation model of gastric cancer fitted China based on Markov model [D]. Changsha: Central South University; 2014. Chong-Qing T. Build pharmacoeconomics evaluation model of gastric cancer fitted China based on Markov model [D]. Changsha: Central South University; 2014.
19.
go back to reference Grothey A, Van Cutsem E, Sobrero A, Siena S, Falcone A, Ychou M, et al. Regorafenib monotherapy for previously treated metastatic colorectal cancer (CORRECT): an international, multicentre, randomised, placebo-controlled, phase 3 trial. Lancet. 2013;381(9863):303–12.CrossRef Grothey A, Van Cutsem E, Sobrero A, Siena S, Falcone A, Ychou M, et al. Regorafenib monotherapy for previously treated metastatic colorectal cancer (CORRECT): an international, multicentre, randomised, placebo-controlled, phase 3 trial. Lancet. 2013;381(9863):303–12.CrossRef
20.
go back to reference Mayer RJ, Van Cutsem E, Falcone A, Yoshino T, Garcia-Carbonero R, Mizunuma N, et al. Randomized trial of TAS-102 for refractory metastatic colorectal cancer. N Engl J Med. 2015;372(20):1909–19.CrossRef Mayer RJ, Van Cutsem E, Falcone A, Yoshino T, Garcia-Carbonero R, Mizunuma N, et al. Randomized trial of TAS-102 for refractory metastatic colorectal cancer. N Engl J Med. 2015;372(20):1909–19.CrossRef
21.
go back to reference Cho SK, Hay JW, Barzi A. Cost-effectiveness analysis of regorafenib and TAS-102 in refractory metastatic colorectal cancer in the United States.[J]. Clin Colorectal Cancer. 2018;17(4):e751–61.CrossRef Cho SK, Hay JW, Barzi A. Cost-effectiveness analysis of regorafenib and TAS-102 in refractory metastatic colorectal cancer in the United States.[J]. Clin Colorectal Cancer. 2018;17(4):e751–61.CrossRef
22.
go back to reference Mailankody S, Prasad V. Five years of cancer drug approvals: innovation, efficacy, and costs.[J]. JAMA Oncol. 2015;1(4):539–40.CrossRef Mailankody S, Prasad V. Five years of cancer drug approvals: innovation, efficacy, and costs.[J]. JAMA Oncol. 2015;1(4):539–40.CrossRef
23.
go back to reference Prasad V, De Jesús K, Mailankody S. The high price of anticancer drugs: origins, implications, barriers, solutions[J]. Nat Rev Clin Oncol. 2017;14(6):381.CrossRef Prasad V, De Jesús K, Mailankody S. The high price of anticancer drugs: origins, implications, barriers, solutions[J]. Nat Rev Clin Oncol. 2017;14(6):381.CrossRef
24.
go back to reference Leech AA, Kim DD, Cohen JT, et al. Use and misuse of cost-effectiveness analysis thresholds in low- and middle-income countries: trends in cost-per-DALY studies[J]. Value Health. 2018;21(7):759–61 S1098301518300160.CrossRef Leech AA, Kim DD, Cohen JT, et al. Use and misuse of cost-effectiveness analysis thresholds in low- and middle-income countries: trends in cost-per-DALY studies[J]. Value Health. 2018;21(7):759–61 S1098301518300160.CrossRef
25.
go back to reference Cameron D, Ubels J, et al. On what basis are medical cost-effectiveness thresholds set? Clashing opinions and an absence of data: a systematic review.[J]. Glob Health Action. 2018;11(1):1447828.CrossRef Cameron D, Ubels J, et al. On what basis are medical cost-effectiveness thresholds set? Clashing opinions and an absence of data: a systematic review.[J]. Glob Health Action. 2018;11(1):1447828.CrossRef
26.
go back to reference Cho SK, Hay JW, Barzi A. Cost-effectiveness analysis of regorafenib and TAS-102 in refractory metastatic colorectal cancer in the United States. Clin Colorectal Cancer. 2018;17(4):e751–e61.CrossRef Cho SK, Hay JW, Barzi A. Cost-effectiveness analysis of regorafenib and TAS-102 in refractory metastatic colorectal cancer in the United States. Clin Colorectal Cancer. 2018;17(4):e751–e61.CrossRef
27.
go back to reference Bullement A, Underhill S, Fougeray R, Hatswell AJ. Cost-effectiveness of trifluridine/tipiracil for previously treated metastatic colorectal cancer in England and Wales. Clin Colorectal Cancer. 2018;17(1):e143–e51.CrossRef Bullement A, Underhill S, Fougeray R, Hatswell AJ. Cost-effectiveness of trifluridine/tipiracil for previously treated metastatic colorectal cancer in England and Wales. Clin Colorectal Cancer. 2018;17(1):e143–e51.CrossRef
28.
go back to reference Hurwitz H, Fehrenbacher L, Novotny W, Cartwright T, Hainsworth J, Heim W, et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med. 2004;350(23):2335–42.CrossRef Hurwitz H, Fehrenbacher L, Novotny W, Cartwright T, Hainsworth J, Heim W, et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med. 2004;350(23):2335–42.CrossRef
29.
go back to reference Bennouna J, Sastre J, Arnold D, Osterlund P, Greil R, Van Cutsem E, et al. Continuation of bevacizumab after first progression in metastatic colorectal cancer (ML18147): a randomised phase 3 trial. Lancet Oncol. 2013;14(1):29–37.CrossRef Bennouna J, Sastre J, Arnold D, Osterlund P, Greil R, Van Cutsem E, et al. Continuation of bevacizumab after first progression in metastatic colorectal cancer (ML18147): a randomised phase 3 trial. Lancet Oncol. 2013;14(1):29–37.CrossRef
30.
go back to reference Tabernero J, Yoshino T, Cohn AL, Obermannova R, Bodoky G, Garcia-Carbonero R, et al. Ramucirumab versus placebo in combination with second-line FOLFIRI in patients with metastatic colorectal carcinoma that progressed during or after first-line therapy with bevacizumab, oxaliplatin, and a fluoropyrimidine (RAISE): a randomised, double-blind, multicentre, phase 3 study. Lancet Oncol. 2015;16(5):499–508.CrossRef Tabernero J, Yoshino T, Cohn AL, Obermannova R, Bodoky G, Garcia-Carbonero R, et al. Ramucirumab versus placebo in combination with second-line FOLFIRI in patients with metastatic colorectal carcinoma that progressed during or after first-line therapy with bevacizumab, oxaliplatin, and a fluoropyrimidine (RAISE): a randomised, double-blind, multicentre, phase 3 study. Lancet Oncol. 2015;16(5):499–508.CrossRef
31.
go back to reference Van Cutsem E, Tabernero J, Lakomy R, Prenen H, Prausova J, Macarulla T, et al. Addition of aflibercept to fluorouracil, leucovorin, and irinotecan improves survival in a phase III randomized trial in patients with metastatic colorectal cancer previously treated with an oxaliplatin-based regimen. J Clin Oncol. 2012;30(28):3499–506.CrossRef Van Cutsem E, Tabernero J, Lakomy R, Prenen H, Prausova J, Macarulla T, et al. Addition of aflibercept to fluorouracil, leucovorin, and irinotecan improves survival in a phase III randomized trial in patients with metastatic colorectal cancer previously treated with an oxaliplatin-based regimen. J Clin Oncol. 2012;30(28):3499–506.CrossRef
32.
go back to reference Wade R, Duarte A, Simmonds M, Rodriguez-Lopez R, Duffy S, Woolacott N, et al. The clinical and cost effectiveness of aflibercept in combination with Irinotecan and fluorouracil-based therapy (FOLFIRI) for the treatment of metastatic colorectal cancer which has progressed following prior oxaliplatin-based chemotherapy: a critique of the evidence. PharmacoEconomics. 2015;33(5):457–66.CrossRef Wade R, Duarte A, Simmonds M, Rodriguez-Lopez R, Duffy S, Woolacott N, et al. The clinical and cost effectiveness of aflibercept in combination with Irinotecan and fluorouracil-based therapy (FOLFIRI) for the treatment of metastatic colorectal cancer which has progressed following prior oxaliplatin-based chemotherapy: a critique of the evidence. PharmacoEconomics. 2015;33(5):457–66.CrossRef
33.
go back to reference Goldstein DA, El-Rayes BF. Considering efficacy and cost, where does ramucirumab fit in the management of metastatic colorectal cancer? Oncologist. 2015;20(9):981–2.CrossRef Goldstein DA, El-Rayes BF. Considering efficacy and cost, where does ramucirumab fit in the management of metastatic colorectal cancer? Oncologist. 2015;20(9):981–2.CrossRef
34.
go back to reference Behl AS, Goddard KA, Flottemesch TJ, Veenstra D, Meenan RT, Lin JS, et al. Cost-effectiveness analysis of screening for KRAS and BRAF mutations in metastatic colorectal cancer. J Natl Cancer Inst. 2012;104(23):1785–95.CrossRef Behl AS, Goddard KA, Flottemesch TJ, Veenstra D, Meenan RT, Lin JS, et al. Cost-effectiveness analysis of screening for KRAS and BRAF mutations in metastatic colorectal cancer. J Natl Cancer Inst. 2012;104(23):1785–95.CrossRef
35.
go back to reference Jung BYH, Daniel MC. Do value thresholds for oncology drugs differ from nononcology drugs?[J]. J Manag Care Pharm. 2014;20(11):1086–92. Jung BYH, Daniel MC. Do value thresholds for oncology drugs differ from nononcology drugs?[J]. J Manag Care Pharm. 2014;20(11):1086–92.
36.
go back to reference Aguiar PN, Roitberg F, Noia Barreto CM, et al. Back to the future: in the era of cost-effectiveness analysis, affordability is a limiting factor for patients’ access to innovative cancer treatments[J]. Value Health Reg Issues. 2019;20:47–50.CrossRef Aguiar PN, Roitberg F, Noia Barreto CM, et al. Back to the future: in the era of cost-effectiveness analysis, affordability is a limiting factor for patients’ access to innovative cancer treatments[J]. Value Health Reg Issues. 2019;20:47–50.CrossRef
Metadata
Title
Cost-effectiveness analysis of fruquintinib for metastatic colorectal cancer third-line treatment in China
Authors
Zhi Peng
Xingduo Hou
Yangmu Huang
Tong Xie
Xinyang Hua
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2020
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-020-07486-w

Other articles of this Issue 1/2020

BMC Cancer 1/2020 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine