Cost-effectiveness analysis of fruquintinib for metastatic colorectal cancer third-line treatment in China
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RESEARCH ARTICLE
Open Access
Cost-effectiveness analysis of fruquintinib for metastatic colorectal cancer third-line treatment in China Zhi Peng1†, Xingduo Hou2†, Yangmu Huang3* , Tong Xie1 and Xinyang Hua4
Abstract Background: In this study, we analyze the cost-effectiveness of fruquintinib as third-line treatment for patients with metastatic colorectal cancer in China, especially after a recent price drop suggested by the National Healthcare Security Administration. Methods: A Markov model was developed to investigate the cost-effectiveness of fruquintinib compared to placebo among patients with metastatic colorectal cancer. Effectiveness was measured in quality-adjusted life years (QALY). The Chinese healthcare payer’s perspective was considered with a lifetime horizon, including direct medical cost (2019 US dollars [USD]). A willing-to-pay threshold was set at USD 27,130/QALY, which is three times the gross domestic product (GDP) per capita. We examined the robustness of the model in one-way and probabilistic sensitivity analysis. Results: Fruquintinib was associated with better health outcomes than placebo (0.640 vs 0.478 QALYs) with a higher cost (USD 20750.9 vs USD 12042.2), resulting in an incremental cost-effectiveness ratio (ICER) of USD 53508.7 per QALY. This ICER is 25% lower than the one calculated before the price drop (USD 70952.6 per QALY). Conclusion: After the price negotiation, the drug becomes cheaper and the ICER is lower, but the drug is still not cost effective under the standard of 3 times GDP willing-to-pay threshold. For patients with metastatic colorectal cancer in China, fruquintinib is not a cost-effective option under the current circumstances in China. Keywords: Metastatic colorectal cancer, Cost-effectiveness analysis, Fruquintinib
Background With increasing incidence and mortality, colorectal cancer is a major public health problem, and has brought constantly heavy economic burden. Over 1.8 million new colorectal cancer cases and 881,000 deaths were estimated to occur in 2018, ranking third in incidence and second in mortality all over the world [1]. The statistics from China not only showed a high prevalence of colorectal cancer in this country with 376,300 new cases and 191,000 deaths in 2015, but a steadily increasing trend of * Correspondence: [email protected] † Zhi Peng and Xingduo Hou contributed equally to this work. 3 Department of Global Health, School of Public Health, Peking University, No.38, Xueyuan Road, Haidian District, Beijing 100191, China Full list of author information is available at the end of the article
incidence and mortality rates over the years which added great stress on Chinese public health [2–4]. Systematic antineoplastic agents represent the main approach in the management of metastatic colorectal cancer (mCRC). Fluorouracil, oxaliplatin, irinotecan, bevacizumab, cetuximab, and panitumumab are widely used alone or in combination for the treatment [5–10]. However, progression was still common after the initial and subsequent palliative care [11
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