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Cost-Effectiveness Analysis of First-Line Cetuximab Plus Leucovorin, Fluorouracil, and Oxaliplatin (FOLFOX-4) versus FOLFOX-4 in Patients with RAS Wild-Type Metastatic Colorectal Cancer

Authors Bai L, Zhang P, Zhou K, Liao W, Li Q

Received 13 June 2019

Accepted for publication 3 December 2019

Published 12 December 2019 Volume 2019:11 Pages 10419—10426


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Beicheng Sun

Liangliang Bai,1,2 Pengfei Zhang,1,2 Kexun Zhou,1,2 Weiting Liao,1,2 Qiu Li1,2

1Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People’s Republic of China; 2West China Biomedical Big Data Center, Sichuan University, Chengdu, Sichuan 610041, People’s Republic of China

Correspondence: Qiu Li
Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, No.37, GuoXue Xiang, Chengdu, Sichuan 610041, People’s Republic of China
Tel +86 288 542 3262
Fax +86 288 542 3609

Purpose: Compared with fluorouracil, leucovorin, and oxaliplatin (FOLFOX-4) alone, cetuximab plus FOLFOX-4 has shown superior performance in terms of efficacy and tolerability in patients with RAS wide-type (wt) metastatic colorectal cancer (mCRC) in the TAILOR trial (Trial No.: EMR62202-057; identifier: NCT01228734). Thus, we aimed to explore the cost-effectiveness of these two first-line regimens in patients with RAS wt mCRC from the Chinese societal perspective.
Methods: For the sake of executing the analysis, we used a Markov model containing three health states (progression-free survival (PFS), progressive disease (PD), and death) to simulate the process of RAS wt mCRC. The data regarding efficacy and safety were derived from the TAILOR trial. Transition probabilities were converted from the PFS and overall survival (OS) of both groups. Utility scores of the health states were obtained from previously published studies. Costs were computed from the perspective of Chinese society. The primary health outcome was the incremental cost-effectiveness ratio (ICER). Sensitivity analysis was utilized to investigate the effect of uncertainties on the Markov model.
Results: Treatment with cetuximab plus FOLFOX-4 was estimated to provide an increase in quality adjusted-life years (QALYs) of 0.15 QALYs at an increased cost of $19,079 compared with FOLFOX-4 alone, resulting in an ICER of $127,193/QALY, which exceeded the threshold of willingness-to-pay (WTP) of $27,934/QALY in China. Sensitivity analysis showed that the cost of PFS in the cetuximab plus FOLFOX-4 arm was the most influential factor in the Markov model.
Conclusion: The combination of cetuximab and FOLFOX-4 is not a cost-effective strategy compared with FOLFOX-4 alone for the first-line treatment of patients with RAS wt mCRC from the perspective of Chinese society.

Keywords: cost-effectiveness, metastatic colorectal cancer, cetuximab, FOLFOX-4

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