OBJECTIVES : To evaluate efficacy, safety and the long-term cost-effectiveness of oxaliplatin-based chemotherapy versus irinotecan-based chemotherapy for the first-line treatment of metastatic advanced colorectal cancer (mCRC) in China.

METHODS : Randomized controlled trials (RCTs) comparing oxaliplatin-based chemotherapy versus irinotecan-based chemotherapy for the first-line treatment of mCRC were systematically searched. A meta-analysis was performed to compare the progression-free survival (PFS), overall survival (OS) and safety of the two groups. A partitioned survival model was built to analyze the life-time costs, quality-adjusted life year (QALY) gained, and incremental cost-effectiveness ratio (ICER) of oxaliplatin-based chemotherapy versus irinotecan-based chemotherapy. Both one-way and probabilistic sensitivity analyses were conducted to assess the uncertainty of parameters.

RESULTS : Ten RCTs were included in the meta-analysis. Patients who received the oxaliplatin-based chemotherapy had higher OS (HR= 0.81, 95 % CI: 0.68 to 0.98; P = 0.03), and higher PFS (HR= 0.84, 95 % CI: 0.67 to 1.04；P= 0.10). In terms of adverse events (grade ≥ 3), the oxaliplatin group had lower rates of diarrhea (RR= 0.53, 95 % CI: 0.42 to 0.56; P< 0.0001), meanwhile had higher rates of neurological events (RR= 20.21; 95 % CI: 7.47 to 54.69; P< 0.0001) and thrombocytopenia (RR= 3.36; 95 % CI: 1.46 to 7.73; P= 0.004). Other adverse event rates were similar between the two groups (P>0.05). The cost-effectiveness analysis showed that compared to irinotecan-based chemotherapy, oxaliplatin-based chemotherapy increased ¥28,101 in average direct medical costs and gained 0.228 more QALYs per patient in a lifetime horizon. The ICER was ¥123,454 /QALY, below commonly cited willingness-to-pay threshold of ¥212,676/QALY (three times GDP per capita in China). Both one-way and probabilistic sensitivity analyses confirmed the robustness of the results.

CONCLUSIONS : Oxaliplatin-based chemotherapy improved health outcomes compared to irinotecan-based chemotherapy and was projected to be more cost-effective for the first-line treatment of mCRC patients in China.