Cost-effectiveness analysis of cetuximab combined with chemotherapy as a first-line treatment for patients with RAS wild-type metastatic colorectal cancer based on the TAILOR trial

Abstract

Objectives: Cetuximab plus leucovorin, fluorouracil and oxaliplatin (FOLFOX-4) is superior to FOLFOX-4 alone as a first-line treatment for patients with metastatic colorectal cancer with RAS wild-type (RAS wt mCRC), with significantly improved survival benefit by TAILOR, an open-label, randomised, multicentre, phase III trial. Nevertheless, the cost-effectiveness of these two regimens remains uncertain. The following study aims to determine whether cetuximab combined with FOLFOX-4 is a cost-effective regimen for patients with specific RAS wt mCRC in China.

Design: A cost-effectiveness model combined decision tree and Markov model was built to simulate pateints with RAS wt mCRC based on health states of dead, progressive and stable. The health outcomes from the TAILOR trial and utilities from published data were used respectively. Costs were calculated with reference to the Chinese societal perspective. The robustness of the results was evaluated by univariate and probabilistic sensitivity analyses.

Participants: The included patients were newly diagnosed Chinese patients with fully RAS wt mCRC.

Interventions: First-line treatment with either cetuximab plus FOLFOX-4 or FOLFOX-4.

Main outcome measures: The primary outcomes are costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs).

Results: Baseline analysis disclosed that the QALYs was increased by 0.383 caused by additional cetuximab, while an increase of US$62 947 was observed in relation to FOLFOX-4 chemotherapy. The ICER was US$164 044 per QALY, which exceeded the willingness-to-pay threshold of US$28 106 per QALY.

Conclusions: Despite the survival benefit, cetuximab combined with FOLFOX-4 is not a cost-effective treatment for the first-line regime of patients with RAS wt mCRC in China.

Trial registration number: TAILOR trial (NCT01228734); Post-results.

Keywords: cetuximab; chemotherapy; cost-effectiveness; metastatic colorectal cancer.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1

The decision tree and Markov model used to simulate a hypothetical cohort of patients with RAS wt mCRC based on the TAILOR trial. Two groups were analysed: group 1, patients with metastatic colorectal cancer treated with cetuximab + FOLFOX-4; and group 2, patients with metastatic colorectal cancer treated with FOLFOX-4. A Markov model comprised three health states (PFS, PD and death). FOLFOX, oxaliplatin, fluorouracil and leucovorin chemotherapy; mCRC, metastatic colorectal cancer; PD, progressive disease; PFS, progression-free survival; wt, wild-type.

Figure 2

Tornado diagrams of one-way sensitivity analyses. Tornado diagrams show the influence of factors on the Markov model of the two strategies in the treatment of metastatic colorectal cancer. The factors are listed in descending order of their influence on ICER with variation in the factor values. ICER, incremental cost-effectiveness ratio; OS, overall survival; PD, progressive disease; PFS, progression-free survival.

Figure 3

Probabilistic sensitivity analysis. (A) Cost-effectiveness acceptability curve. The cost-effectiveness acceptability frontier shows the probability of strategies being cost-effective in two strategies. (B) Scatterplot of 1000 iterations of Monte Carlo simulations. FOLFOX, oxaliplatin, fluorouracil and leucovorin; QALY, quality-adjusted life-year; WTP, willingness-to-pay