OBJECTIVES : Colorectal cancer is the third most common cancer in males and the second in females globally. The costs associated with metastatic colorectal cancer (mCRC) and its burden in Kazakhstan warrant the need for identifying the most effective and efficient treatment options for this disease. The CEA of the regorafenib (RGFB) treatment in patients with mCRC compared to best supportive care (BSC) and two drugs (cetuximab and panitumumab) was conducted.

METHODS : A Markov model was constructed to evaluate RGFB versus BSC from a payer's perspective, using data from CORRECT trial to inform parameters and local costs data. Secondly, in light of current local treatment guidelines, an additional model comparing 4 treatment sequences (RGFB-cetuximab (RC) and RGFB-panitumumab (RP) vs cetuximab-RGFB (CR) and panitumumab-RGFB (PR)) was constructed using data from REVERSE trial. The exchange rate used is dated by June 2019 according to the current market rate in Kazakhstan.

RESULTS : Compared to BSC, RGFB had additional costs of 5245000 KZT (13658.8 USD) and produce additional 0.025 QALY per patient, which amounts to an ICER of ₸212187581 (552571.8 USD) per QALY. Using the WHO's approach to defining willingness-to-pay thresholds, the ICER of RGFB versus BSC obtained in this model exceeds the threshold by a factor of 24. The analysis of treatment sequences revealed an ICER of 11996900 KZT (31241.9 USD) per QALY for RC compared to CR and an ICER of 10033300 KZT (26128.38 USD) per QALY for RP compared to PR.

CONCLUSIONS : Within the budget constraints of the healthcare system of Kazakhstan, regorafenib monotherapy currently does not appear to be a cost-effective third-line treatment option for mCRC compared to BSC. However, given the context of terminal stage cancer treatments, such technologies may still be considered for life-prolonging purposes. Moreover, recent trials suggest improved outcomes of RC and RP sequences, which requires further assessment.