Regorafenib versus Cetuximab plus Irinotecan in Third-line Metastatic Colorectal Cancer in Iran: A Model-based Cost-utility Analysis

Abstract

Background: Metastatic colorectal cancer (mCRC) constitutes a significant health burden globally, accompanied by elevated mortality rates. This study aimed to assess the cost-effectiveness of regorafenib, an orally administered multi-kinase inhibitor, compared to the combination of Cetuximab and Irinotecan (CetIri) as third-line therapy for mCRC in Iran.Method: A model-based cost-utility analysis was conducted employing a semi-Markov model for a hypothetical cohort of 1,000 patients, integrating time-dependent transition probabilities. From the perspective of the Iranian healthcare payer, the analysis included direct medical costs, such as therapy, monitoring, and adverse effect-related expenses, sourced from national databases in Iran. A yearly discount rate of 5% was applied to both costs and outcomes. Data analysis utilized Microsoft Excel, R version 4.1.3, and TreeAge Pro Healthcare version 2022 software, with the significance threshold set at 0.05.Results: The base-case analysis revealed that regorafenib offers a cost saving of $12,154 and an incremental gain of 0.1 quality-adjusted life years per patient over a 19-month horizon compared with the CetIri regimen. Probabilistic sensitivity analysis showed a greater than 99% probability of regorafenib being cost-effective.Conclusion: Consistent with existing evidence, the findings advocate regorafenib as a cost-effective alternative to CetIri for third-line treatment of mCRC in Iran, considering the specific healthcare system context. Given the foundational assumptions, caution is advised when extrapolating these results to other regions.

Keywords

• economic evaluation
• survival analysis
• chemotherapy
• angiogenesis inhibitors
• quality-adjusted life years