COST-EFFECTIVENESS OF TRIFLURIDINE/TIPIRACIL PLUS BEVACIZUMAB VERSUS REGORAFENIB IN REFRACTORY METASTATIC COLORECTAL CANCER IN KAZAKHSTAN
Author(s)
Talgat S. Nurgozhin, Sr., PhD, MD1, Shynggys Sergazy, PhD2, Alima Almadiyeva, MSc, MSPH, MD3, Alexander Kostyuk, PhD, MD1, Abrakhmanov Ramil, PhD, MD4;
1Kazakhstan Association of health technologies assessment, evidence based medicine and pharmacoecon, Astana, Kazakhstan, 2Astana, Kazakhstan, 3KazSPOR, Astana, Kazakhstan, 4Kazakh Institute of Oncology and Radiology, Almaty, Kazakhstan
1Kazakhstan Association of health technologies assessment, evidence based medicine and pharmacoecon, Astana, Kazakhstan, 2Astana, Kazakhstan, 3KazSPOR, Astana, Kazakhstan, 4Kazakh Institute of Oncology and Radiology, Almaty, Kazakhstan
OBJECTIVES: Refractory metastatic colorectal cancer (mCRC) is associated with poor prognosis and high treatment costs. Recent evidence indicates that trifluridine/tipiracil (FTD/TPI) plus bevacizumab improves survival outcomes compared with regorafenib. This study aimed to assess the cost-effectiveness of FTD/TPI plus bevacizumab versus regorafenib from the healthcare system perspective of the Republic of Kazakhstan.
METHODS: A cost-utility analysis was performed using a model-based approach. The target population included patients with refractory mCRC and preserved functional status (ECOG 0-1). Clinical efficacy data were derived from the SUNLIGHT trial and the CORRECT trial. Health outcomes were expressed in quality-adjusted life years (QALYs). Utility values were obtained from published literature. Direct medical costs included drug acquisition, administration, monitoring, and management of adverse events, calculated in 2025 Kazakhstani tenge (₸). The incremental cost-effectiveness ratio (ICER) was compared against a willingness-to-pay threshold of 1-3 times gross domestic product (GDP) per capita per QALY. Deterministic sensitivity analyses were conducted to test the robustness of the results.
RESULTS: FTD/TPI plus bevacizumab demonstrated improved overall survival (approximately +4.4 months) and longer progression-free survival compared with regorafenib. The combination therapy yielded higher QALYs, reflecting better disease control and quality of life. The ICER for FTD/TPI plus bevacizumab ranged from approximately ₸6.1 million to ₸18.3 million per QALY for 6-8 treatment cycles, remaining within the accepted willingness-to-pay threshold for Kazakhstan. Sensitivity analyses identified drug costs and QALY estimates as the primary drivers of ICER variability; however, the overall conclusion remained stable across plausible parameter ranges.
CONCLUSIONS: From the healthcare system perspective of Kazakhstan, trifluridine/tipiracil plus bevacizumab is a cost-effective alternative to regorafenib for patients with refractory metastatic colorectal cancer and good performance status. Incorporation of this regimen into clinical practice may improve patient outcomes while supporting efficient allocation of limited oncology resources.
METHODS: A cost-utility analysis was performed using a model-based approach. The target population included patients with refractory mCRC and preserved functional status (ECOG 0-1). Clinical efficacy data were derived from the SUNLIGHT trial and the CORRECT trial. Health outcomes were expressed in quality-adjusted life years (QALYs). Utility values were obtained from published literature. Direct medical costs included drug acquisition, administration, monitoring, and management of adverse events, calculated in 2025 Kazakhstani tenge (₸). The incremental cost-effectiveness ratio (ICER) was compared against a willingness-to-pay threshold of 1-3 times gross domestic product (GDP) per capita per QALY. Deterministic sensitivity analyses were conducted to test the robustness of the results.
RESULTS: FTD/TPI plus bevacizumab demonstrated improved overall survival (approximately +4.4 months) and longer progression-free survival compared with regorafenib. The combination therapy yielded higher QALYs, reflecting better disease control and quality of life. The ICER for FTD/TPI plus bevacizumab ranged from approximately ₸6.1 million to ₸18.3 million per QALY for 6-8 treatment cycles, remaining within the accepted willingness-to-pay threshold for Kazakhstan. Sensitivity analyses identified drug costs and QALY estimates as the primary drivers of ICER variability; however, the overall conclusion remained stable across plausible parameter ranges.
CONCLUSIONS: From the healthcare system perspective of Kazakhstan, trifluridine/tipiracil plus bevacizumab is a cost-effective alternative to regorafenib for patients with refractory metastatic colorectal cancer and good performance status. Incorporation of this regimen into clinical practice may improve patient outcomes while supporting efficient allocation of limited oncology resources.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE60
Topic
Economic Evaluation
Disease
SDC: Oncology