OBJECTIVES : To evaluate the efficacy, safety and long-term cost-effectiveness of Oxaliplatin-based chemotherapy plus targeted molecular agents (Ox-based regimens) versus Irinotecan-based chemotherapy plus targeted molecular agents (Iri-based regimens) as the first-line treatment of metastatic advanced colorectal cancer (mCRC) from Chinese healthcare system perspective.

METHODS : Randomized controlled trials (RCTs) comparing Ox-based regimens versus Iri-based regimens for the treatment of mCRC were systematically searched and a meta-analysis was performed to compare the progression-free survival (PFS), overall survival (OS) and safety of Ox-based regimens and Iri-based regimens. Given the similar PFS and OS in Meta-analysis results, a cost-minimization analysis method was used to calculate and compare the life-time direct medical costs of Ox-based regimens and Iri-based regimens.

RESULTS : Nine RCTs were included in the meta-analysis. The results demonstrated that patients in the two groups had similar OS (HR=1.02; 95 % CI: 0.91 to 1.15, P=0.72) and PFS (HR=1.07; 95 % CI: 0.98 to 1.17; P=0.16). In terms of adverse events (grade≥3), the Ox-based regimens group had lower rates of febrile neutropenia (RR=0.31; 95 % CI: 0.11 to 0.87; P=0.03) and leukopenia (RR=0.44; 95 % CI: 0.23 to 0.85; P=0.01), while it had higher rates of neurological events (RR=27.74; 95 % CI: 7.88 to 97.57; P<0.001) and thrombocytopenia (RR=7.88; 95 % CI: 2.39 to 26.02; P<0.001). There was no significant difference in other adverse event rates (P>0.05). The cost-minimization analysis showed that Ox-based regimens saved ¥39,355 per patient in direct medical costs in a lifetime horizon compared with Iri-based regimens.

CONCLUSIONS : The two regimens have similar efficacy and safety profiles. Ox-based regimens are of better economic value with lower overall costs compared with Iri-based regimens for the treatment of mCRC patients in China.