OBJECTIVES

: The objective of this study was to calculate an incremental cost-effectiveness ratio (ICER) of Regorafenib as a third-line treatment therapy, compared to placebo plus best supportive care (BSC) in Chinese patients with metastatic colorectal cancer, who failed second-line treatment.

METHODS

A life-time Markov model was developed using the Chinese healthcare system perspective. Data extracted from a clinical trial (CONCUR) were used to calculate transition probabilities of survival. Each state utility and adverse events’ incidence rates were also obtained from CONCUR. Drug costs were the average wholesale price after reimbursement. Other healthcare utilization costs were obtained from literature. Costs and quality-adjusted life-years (QALYs) were both discounted at 5%. Three times of GDP per capita (¥193,932 or 27,576 US dollars) was used as the willingness-to-pay (WTP) value per QALY.

RESULTS

The discounted total cost, life year (LY) and QALY of Regorafenib were ¥188,534, 0.85 LYs, and 0.62 QALYs, respectively. The discounted total cost, life year, and QALY of the control group were ¥106,835, 0.61 LYs, and 0.44 QALYs, respectively. The base case analysis showed that compared to the placebo group, Regorafenib added 11 weeks of life (0.23 LYs) and 9 quality-adjusted life-weeks (0.19 QALYs) on average, and the ICER was ¥444,356/QALY, higher than the WTP threshold (¥193,932/QALY). Univariate sensitivity analysis indicated that the most influential parameters of the ICERs were cost of Regorafenib and intensity of Regorafenib. The probabilistic sensitivity analysis showed the probability of Regorafenib being cost-effective >50% only when WTP was greater than ¥535,000/QALY, more than double the current threshold.

CONCLUSIONS

Use of Regorafenib as the third-line therapy is not cost-effective at the WTP threshold of ¥193,932, compared to the placebo group among patients who failed in the second-line treatment of metastatic colorectal cancer. Furthermore, sensitivity analyses did not alter the findings.