Cost-Effectiveness Analysis of FOLFIRI-Based First-Line Regimens for Metastatic Colorectal Cancer Using Clinical...

Area of Science:

• Oncology
• Health Economics
• Clinical Pharmacology

Background:

• Metastatic colorectal cancer (mCRC) with KRAS wild type is a significant clinical challenge.
• Standard treatment regimens include fluorouracil, irinotecan, and Leucovorin (FOLFIRI) combined with bevacizumab (Bmab), cetuximab (Cmab), or panitumumab (Pmab).

Purpose of the Study:

• To identify the optimal treatment regimen for KRAS wild type metastatic colorectal cancer.
• To evaluate the clinical and economic evidence of different drug combinations.

Main Methods:

• A Markov model with monthly cycles was employed for decision analysis.
• Probabilistic variables were sourced from randomized controlled trials.
• Direct medical costs, including drugs and staff, were calculated and integrated into the model.

Main Results:

• FOLFIRI alone resulted in 20.9 months survival at 2,299,198 yen.
• Combination therapies offered longer survival but at significantly higher costs: Bmab (29.9 months, 8,929,888 yen), Cmab (27.8 months, 11,811,849 yen), and Pmab (22.6 months, 8,795,622 yen).
• Incremental cost-effectiveness ratios ranged from 736,743 yen/month to 3,821,426 yen/month, indicating substantial additional cost per month of survival.

Conclusions:

• While combination regimens demonstrate excellent therapeutic efficacy for mCRC, they are not sufficiently cost-effective.
• From an economic perspective, FOLFIRI alone is a superior treatment option compared to the evaluated combination therapies.