COST-EFFECTIVENESS ANALYSIS OF FOLFOXIRI VERSUS FOLFIRI FOR METASTATIC COLORECTAL CANCER
Author(s)
Mao Yamaguchi1, Hina Yoshimoto2, Ryutaro Sakai3, Seiya Taniguchi3, Kensuke Moriwaki, BS, MS, PhD4.
1Student, Ritsumeikan university, Kusatsu, Japan, 2Ritsumeikan University, Japan, 3Ritsumeikan University, Kusatsu, Japan, 4Ritsumeikan University, Kyoto, Japan.
1Student, Ritsumeikan university, Kusatsu, Japan, 2Ritsumeikan University, Japan, 3Ritsumeikan University, Kusatsu, Japan, 4Ritsumeikan University, Kyoto, Japan.
OBJECTIVES: This study aimed to evaluate the cost-effectiveness of FOLFOXIRI from the perspective of the Japanese public healthcare payer.
METHODS: A partitioned survival analysis (PartSA) model was developed to estimate costs and quality-adjusted life years (QALYs) for the FOLFOXIRI and FOLFIRI groups. Survival data were obtained from the GONO trial. Drug costs for FOLFOXIRI were calculated based on Japanese drug prices. Other cost parameters were estimated using statistical analyses of the JMDC claims database. A lifetime horizon was applied, and both future costs and health outcomes were discounted at an annual rate of 2%. Utility values were derived from previous studies. The incremental cost-effectiveness ratio (ICER), defined as incremental cost divided by incremental QALYs, was calculated for FOLFOXIRI compared with FOLFIRI. Sensitivity analyses were conducted to evaluate uncertainty in model parameters.
RESULTS: Compared with the FOLFIRI group, the FOLFOXIRI group incurred an additional cost of JPY 7,740,141 and achieved an incremental gain of 0.7269 QALYs. The resulting ICER was JPY 10,648,888 per QALY gained. Sensitivity analyses showed that the utility value for the progression-free state in the FOLFOXIRI group had the greatest impact on the ICER. Across all sensitivity analyses, the ICER remained below the willingness-to-pay threshold of JPY 15 million/QALY, which is commonly used in cost-effectiveness evaluations of anticancer drugs in Japan.
CONCLUSIONS: Using a willingness-to-pay threshold of JPY 15 million/QALY, FOLFOXIRI was shown to be cost-effective compared with FOLFIRI as first-line treatment for metastatic colorectal cancer. These findings support the economic value of FOLFOXIRI therapy and provide insight into the economic aspects of treatment selection for metastatic colorectal cancer.
METHODS: A partitioned survival analysis (PartSA) model was developed to estimate costs and quality-adjusted life years (QALYs) for the FOLFOXIRI and FOLFIRI groups. Survival data were obtained from the GONO trial. Drug costs for FOLFOXIRI were calculated based on Japanese drug prices. Other cost parameters were estimated using statistical analyses of the JMDC claims database. A lifetime horizon was applied, and both future costs and health outcomes were discounted at an annual rate of 2%. Utility values were derived from previous studies. The incremental cost-effectiveness ratio (ICER), defined as incremental cost divided by incremental QALYs, was calculated for FOLFOXIRI compared with FOLFIRI. Sensitivity analyses were conducted to evaluate uncertainty in model parameters.
RESULTS: Compared with the FOLFIRI group, the FOLFOXIRI group incurred an additional cost of JPY 7,740,141 and achieved an incremental gain of 0.7269 QALYs. The resulting ICER was JPY 10,648,888 per QALY gained. Sensitivity analyses showed that the utility value for the progression-free state in the FOLFOXIRI group had the greatest impact on the ICER. Across all sensitivity analyses, the ICER remained below the willingness-to-pay threshold of JPY 15 million/QALY, which is commonly used in cost-effectiveness evaluations of anticancer drugs in Japan.
CONCLUSIONS: Using a willingness-to-pay threshold of JPY 15 million/QALY, FOLFOXIRI was shown to be cost-effective compared with FOLFIRI as first-line treatment for metastatic colorectal cancer. These findings support the economic value of FOLFOXIRI therapy and provide insight into the economic aspects of treatment selection for metastatic colorectal cancer.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
EE100
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Oncology