OBJECTIVES: To evaluate the cost-effectiveness of trifluridine and tipiracil hydrochloride (FTD/TPI) compared with best supportive care (BSC) or regorafenib for the treatment of patients with metastatic colorectal cancer (mCRC) who have been previously treated with or are not considered candidates for available therapies including fluoropyrimidine-, oxaliplatin- and irinotecan-based chemotherapies, anti-vascular endothelial growth factor agents and anti-epidermal growth factor receptor agents in Greece.

METHODS: A partitioned survival model was locally adapted from a third-party payer perspective over a 10-year time horizon. Efficacy, safety data and utility values were extracted from relevant clinical trials and published studies. Resource consumption data were obtained from local experts, using a questionnaire developed for the purpose of the study and was combined with unit costs obtained from official sources. All costs reflect the year 2017 in euros. Primary outcomes were patients’ life years (LYs), quality-adjusted life years (QALYs), total costs and incremental cost-effectiveness ratios (ICERs) per QALY and LYs gained. Both cost and outcomes were discounted at 3.5% per year. A threshold of €51,000 per QALY gained was used (3 times the GDP per capita of Greece based on WHO Guidelines). A probabilistic sensitivity analysis (PSA) was conducted.

RESULTS: Total life time cost per patient for FTD/TPI, BSC and Regorafenib was estimated to be €10,443, €1,879 and €11,094 respectively. In terms of health outcomes, FTD/TPI was associated with 0.25 and 0.11 increment in LYs compared with BSC and Regorafenib respectively. Furthermore, FTD/TPI was associated with 0.17, and 0.07 increment in QALYs compared with BSC and Regorafenib, resulting in ICERs of €34,137 per LY gained and €49,732 per QALY gained versus BSC. Moreover, FTD/TPI was a dominant alternative over Regorafenib. PSA confirmed the deterministic results.

CONCLUSIONS: The results indicate that FTD/TPI may represent a cost–effective treatment option compared to other alternative therapies as a third-line treatment of mCRC in Greece.