Value-Based Assessment of Trifluridine Tipiracil and Bevacizumab in Refractory Metastatic Colorectal Cancer
Author(s)
João Henriques, PharmD1, Ana Paula Amorim, PharmD2, Angela Antonio, PharmD3, Márcio Silva, MSc4, João Rocha, MSc5, Jorge Felix Parreia, MSc6, Sana Yahiaoui, MSc7.
1SERVIER PORTUGAL, LDA., LISBON, Portugal, 2SERVIER PORTUGAL, LISBON, Portugal, 3Servier Portugal-Especialidades Farmacêuticas, Lda., Lisbon, Portugal, 4Exigo Consultores LDA, Lisboa, Portugal, 5Exigo Consultores LDA, Lisbon, Portugal, 6Director, Exigo Consultores LDA, Lisboa, Portugal, 7Servier International, Paris, France.
1SERVIER PORTUGAL, LDA., LISBON, Portugal, 2SERVIER PORTUGAL, LISBON, Portugal, 3Servier Portugal-Especialidades Farmacêuticas, Lda., Lisbon, Portugal, 4Exigo Consultores LDA, Lisboa, Portugal, 5Exigo Consultores LDA, Lisbon, Portugal, 6Director, Exigo Consultores LDA, Lisboa, Portugal, 7Servier International, Paris, France.
OBJECTIVES: Metastatic Colorectal Cancer (mCRC) is associated with poor prognosis and 5-Year relative survival under 20%. Trifluridine/tipiracil plus bevacizumab is recommended by ESMO, NCCN and ASCO clinical guidelines for third line refractory mCRC. We performed a value-based assessment of trifluridine/tipiracil plus bevacizumab in mCRC measuring both clinically meaningful outcomes for patients (OS, QoL, treatment mortality, treatment interruption, and grade 3/4 AEs) and economic implications for public payers.
METHODS: A long-term semi-Markov partitioned survival model was adapted to evaluate the cost-effectiveness of trifluridine/tipiracil plus bevacizumab relative to trifluridine/tipiracil alone. Efficacy, safety and health state utility values from the SUNLIGHT trial (NCT04737187) contributed to life years (LY) and quality-adjusted life-years (QALYs) estimation. Only direct medical costs related to medicines, adverse events, health resource use, subsequent treatments and terminal care were considered. Modelling robustness was checked with Monte-Carlo probabilistic sensitivity analyses assuming 5% significance level. We adopt the public NHS perspective.
RESULTS: Use of trifluridine/tipiracil plus bevacizumab as third-line treatment for mCRC resulted in mean overall survival of 1.35LY (95%CI, 1.29-1.42) and incremental benefit of 0.40LY (95%CI, 0.32-0.49) over monotherapy with trifluridine/tipiracil. QALYs were substantially improved with trifluridine/tipiracil plus bevacizumab 1.12QALY vs 0.75QALY (difference 0.37QALY: 95%CI, 0.30-0.44). These outcomes were considered of major therapeutic added value by the Portuguese HTA body. On average, total costs were 56.3% (95%CI, 52.3%-59.7%) higher with trifluridine/tipiracil plus bevacizumab and were mainly driven by longer treatment duration (5.0 vs. 2.5 months). The economic model used a 15-year time horizon. The mean incremental cost-effectiveness ratio (undiscounted) of trifluridine/tipiracil plus bevacizumab (biosimilar: 94.5% of market share) was €24,012/QALY, with 96.7% probability of being cost-effective below €30,000/QALY threshold.
CONCLUSIONS: Trifluridine/tipiracil plus bevacizumab as third-line treatment for metastatic colorectal cancer improves life expectancy and quality of life while providing good value for money from a European public payers' perspective.
METHODS: A long-term semi-Markov partitioned survival model was adapted to evaluate the cost-effectiveness of trifluridine/tipiracil plus bevacizumab relative to trifluridine/tipiracil alone. Efficacy, safety and health state utility values from the SUNLIGHT trial (NCT04737187) contributed to life years (LY) and quality-adjusted life-years (QALYs) estimation. Only direct medical costs related to medicines, adverse events, health resource use, subsequent treatments and terminal care were considered. Modelling robustness was checked with Monte-Carlo probabilistic sensitivity analyses assuming 5% significance level. We adopt the public NHS perspective.
RESULTS: Use of trifluridine/tipiracil plus bevacizumab as third-line treatment for mCRC resulted in mean overall survival of 1.35LY (95%CI, 1.29-1.42) and incremental benefit of 0.40LY (95%CI, 0.32-0.49) over monotherapy with trifluridine/tipiracil. QALYs were substantially improved with trifluridine/tipiracil plus bevacizumab 1.12QALY vs 0.75QALY (difference 0.37QALY: 95%CI, 0.30-0.44). These outcomes were considered of major therapeutic added value by the Portuguese HTA body. On average, total costs were 56.3% (95%CI, 52.3%-59.7%) higher with trifluridine/tipiracil plus bevacizumab and were mainly driven by longer treatment duration (5.0 vs. 2.5 months). The economic model used a 15-year time horizon. The mean incremental cost-effectiveness ratio (undiscounted) of trifluridine/tipiracil plus bevacizumab (biosimilar: 94.5% of market share) was €24,012/QALY, with 96.7% probability of being cost-effective below €30,000/QALY threshold.
CONCLUSIONS: Trifluridine/tipiracil plus bevacizumab as third-line treatment for metastatic colorectal cancer improves life expectancy and quality of life while providing good value for money from a European public payers' perspective.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE747
Topic
Economic Evaluation, Health Technology Assessment
Disease
Oncology