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

Abstract

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; ClinicalTrials.gov 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: FOLFOX-4; cetuximab; cost-effectiveness; metastatic colorectal cancer.

Conflict of interest statement

The authors report no conflicts of interest in this work.

© 2019 Bai et al.

Figures

Figure 1

Markov model for RAS wide-type metastatic colorectal cancer. Notes: A Markov model containing three health states (progression-free state, progressive disease, and death) was conducted.

Figure 2

Tornado diagram of the one-way sensitivity analysis. Notes: The tornado diagram showed the results of the one-way sensitivity analysis to observe the effect of different parameters on the Markov model. The parameters are arranged in descending order in terms of trend with the degree of influence on the Markov model. Abbreviations: FOLFOX-4, leucovorin, fluorouracil, and oxaliplatin; combination arm, cetuximab plus FOLFOX-4 arm; PFS, progression-free survival; PD, progressive disease; QALM, quality adjusted-life month; ICER, incremental cost-effectiveness ratio.

Figure 3

Cost-effectiveness acceptability curves. Notes: The curves show the results of probabilistic sensitivity analysis to determine the optimal strategy under the premise of varying willingness-to-pay thresholds. Abbreviations: FOLFOX-4, leucovorin, fluorouracil, and oxaliplatin; CE, cost-effectiveness; QALM, quality-adjusted life month.