OBJECTIVES : This study aimed to assess the cost-effectiveness of Fruquintinib versus Regorafenib as the third-line therapyfor patients with metastatic colorectal cancer in China.

METHODS : A Three-state Markov model with monthly cycle was developed to estimate lifetime incremental cost-effectiveness ratio (ICER) of Fruquintinib versus Regorafenib as the third-line therapy for patients with metastatic colorectal cancer from Chinese health-care system perspective. Survival analysis was conducted to calculate transition probabilities using the data from two clinical trials (FRESCO and CONCUR) from which we also extracted the incidence of adverse events. Mortality rate and drug costs were derived from government published data. Costs for medical services were obtained from published literatures and a real world study about economic burden of Chinese metastatic colorectal cancer patients. Utilities applied to calculate the quality adjusted life years (QALYs) were obtained through literature review. Costs and QALYs were discounted at a 5% annual rate. One way sensitivity analysis and probabilistic sensitivity analysis were conducted to demonstrate the robustness of the results.

RESULTS : Fruquintinib provided 0.74 QALYs at a cost of CNY 177863.75, whereas Regorafenib provided 0.79 QALYs at a cost of CNY 248277.29. Compared to Fruquintinib, the ICER of Regorafenib was CNY 1416749.10/QALY, which was above three times GDP per capita of China in 2017 (CNY 59660) as the threshold to define the cost-effectiveness. One-way sensitivity analysis showed the results were generally robust. Cost-effectiveness acceptability curves derived from the probabilistic sensitivity analysis demonstrated that Fruquintinib was 100% more cost-effective, when the threshold was three times GDP per capita of China.

CONCLUSIONS : Compared to Regorafenib, Fruquintinib can be regarded as a cost-effective choice as the third-line therapy for patients with metastatic colorectal cancer in China.