Cost-effectiveness analysis of trifluridine/tipiracil combined with bevacizumab vs. monotherapy for third-line treatment of colorectal cancer

Front Public Health. 2024 Nov 13:12:1465898. doi: 10.3389/fpubh.2024.1465898. eCollection 2024.

Abstract

Background: The combination of trifluridine/tipiracil (FTD/TPI) and bevacizumab has demonstrated promising efficacy and safety in the treatment of colorectal cancer (CRC). This study aims to evaluate the cost-effectiveness of trifluridine/tipiracil combined with bevacizumab vs. trifluridine/tipiracil monotherapy as a third-line treatment regimen for colorectal cancer within the Chinese healthcare system, providing an economic basis for clinical application.

Methods: Based on data from the SUNLIGHT Phase III clinical trial, a dynamic Markov model was constructed with a cycle length of 4 weeks and a simulation duration of 10 years. Direct medical costs and quality-adjusted life years (QALYs) were calculated. The incremental cost-effectiveness ratio (ICER) was compared with the willingness-to-pay threshold (WTP = ¥268,200.00/QALY) to assess the economic viability of the treatment regimen. One-way sensitivity analysis and probabilistic sensitivity analysis were conducted to verify the robustness of the model results.

Results: The cost of trifluridine/tipiracil combined with bevacizumab treatment (¥838,492.74) was higher than that of trifluridine/tipiracil monotherapy (¥357,396.97), with greater health benefits (2.45 QALYs vs. 1.54 QALYs). The ICER was ¥527,577.36/QALY, exceeding the willingness-to-pay threshold. One-way sensitivity analysis indicated that drug costs and utility values during the progression-free period significantly impacted model outputs. Probabilistic sensitivity analysis further confirmed the robustness of the results, showing that at a willingness-to-pay threshold of ¥494,000.00, the probability of the combined treatment being cost-effective was 50%.

Conclusion: Trifluridine/tipiracil combined with bevacizumab, as a third-line treatment for colorectal cancer, does not have a cost-effectiveness advantage compared to trifluridine/tipiracil monotherapy in economic evaluations.

Keywords: Markov model; bevacizumab; colorectal cancer; cost-effectiveness analysis; trifluridine/tipiracil.

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols* / economics
  • Antineoplastic Combined Chemotherapy Protocols* / therapeutic use
  • Bevacizumab* / economics
  • Bevacizumab* / therapeutic use
  • China
  • Colorectal Neoplasms* / drug therapy
  • Colorectal Neoplasms* / economics
  • Cost-Benefit Analysis*
  • Cost-Effectiveness Analysis
  • Drug Combinations*
  • Female
  • Humans
  • Male
  • Markov Chains
  • Middle Aged
  • Pyrrolidines* / economics
  • Pyrrolidines* / therapeutic use
  • Quality-Adjusted Life Years
  • Thymine* / economics
  • Thymine* / therapeutic use
  • Trifluridine* / economics
  • Trifluridine* / therapeutic use

Substances

  • Bevacizumab
  • Trifluridine
  • Thymine
  • Pyrrolidines
  • trifluridine tipiracil drug combination
  • Drug Combinations

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This study was supported by the National Key Clinical Specialty Construction Project (Clinical Pharmacy) and High-Level Clinical Key Specialty (Clinical Pharmacy) in Guangdong Province, with the funder being the subsidy fund for medical service and security capacity improvement of the Central Department of Finance, NO. Z155080000004.