Presentation (CTI)

OBJECTIVES: Metastatic colorectal cancer (mCRC) is one of the leading causes of cancer mortality in Brazil. This study evaluates the cost-effectiveness of regorafenib versus FTD-TPI (trifluridine-tipiracil) + bevacizumab (beva) in mCRC patients, from the perspective of the Brazilian supplementary health system.
METHODS: Progression-free and overall survival data from the prospective observational OSERO study (Chida A et al. 2024), for regorafenib and FTD-TPI + bevacizumab, were used to extrapolate survival curves. A partitioned survival model with three health states was developed: pre-progression, post-progression, and death. Costs included medications based on the manufacturing list price with taxes of regorafenib and FTD-TPI and taking into account the lowest-listed price of similar drug available for bevacizumab. Additionally, costs for adverse event management and disease monitoring were derived from the economic model of FTD-TPI submitted to the Brazilian supplementary health agency. The time horizon was 10 years with 28-days cycles. Outcomes analyzed included life years (LY) and quality-adjusted life years (QALY). Sensitivity analyses assessed the impact of uncertainty in the results.
RESULTS: Regorafenib had a total cost of BRL 67,921.57 and generated 0.719 QALY, while the combination of FTD-TPI + bevacizumab had a total cost of BRL 142,064.33 with 0.702 QALY. Regorafenib was more cost effective over FTD-TPI + bevacizumab, with a negative incremental cost of BRL -4,556,326.82 and an incremental benefit of 0.016 QALY.
CONCLUSIONS: Regorafenib demonstrated a dominant alternative compared to FTD-TPI + bevacizumab for patients with mCRC in Brazil. Additionally, several factors may influence the outcomes of this cost-effectiveness analysis, such as the baseline characteristics of the population, the potential benefits of the regorafenib’s ReDOS regimen, drug prices and tax exemptions.