Department of Oncology, Xiangya Hospital, Central South University, Changsha, China.
Department of Pathology, Xiangya Hospital, Central South University, Changsha, China.
Cancer Control. 2020 Jan-Dec;27(1):1073274820902271. doi: 10.1177/1073274820902271.
The FIRE-3 phase III clinical trial demonstrated the marked advantage of prolonging the median overall survival of patients with final RAS wild-type (WT) left-sided metastatic colorectal cancer (mCRC) by 38.3 months after treatment with irinotecan, fluorouracil, and leucovorin (FOLFIRI) plus cetuximab and by 28.0 months after treatment with FOLFIRI plus bevacizumab. However, the substantial cost increase and economic impact of using cetuximab imposes a considerable burden on patients and society.
A Markov model based on the data collected in the FIRE-3 trial was developed to investigate the cost-effectiveness of treating patients with FOLFIRI plus either cetuximab or bevacizumab from the perspective of the Chinese health-care system. Costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated over a lifetime horizon. One-way and probabilistic sensitivity analyses were performed by varying potentially modifiable parameters.
In our analysis, the total treatment costs in the bevacizumab and cetuximab groups were $92 549.31 and $94 987.31, respectively, and the QALYs gained were 1.58 and 2.05. In the base-case analysis, compared with bevacizumab, left-sided RAS WT patients receiving cetuximab gained 0.47 more QALYs at an ICER of $5187.23/QALY ($3166.23/LY). The 1-way sensitivity analysis showed that the most influential parameter was the cost of cetuximab. Probabilistic sensitivity analysis indicated that the cost-effective probability of cetuximab group was 92.8% under the willingness-to-pay threshold of $24 081.
Treatment with FOLFIRI plus cetuximab in Chinese patients with left-sided RAS WT mCRC may improve health outcomes and use financial resources more efficiently than FOLFIRI plus bevacizumab.
FIRE-3 期临床试验表明，在接受伊立替康、氟尿嘧啶和亚叶酸（FOLFIRI）加西妥昔单抗治疗后，最终 RAS 野生型（WT）左侧转移性结直肠癌（mCRC）患者的中位总生存期延长了 38.3 个月，在接受 FOLFIRI 加贝伐珠单抗治疗后延长了 28.0 个月。然而，西妥昔单抗的大量成本增加和经济影响给患者和社会带来了相当大的负担。
基于 FIRE-3 试验收集的数据，建立了一个马尔可夫模型，从中国医疗保健系统的角度研究了 FOLFIRI 加西妥昔单抗或贝伐珠单抗治疗患者的成本效益。在终身时间范围内计算了成本、质量调整生命年（QALYs）和增量成本效益比（ICERs）。通过改变潜在的可改变参数进行了单因素和概率敏感性分析。
在我们的分析中，贝伐珠单抗组和西妥昔单抗组的总治疗费用分别为 92549.31 美元和 94987.31 美元，获得的 QALYs 分别为 1.58 和 2.05。在基础病例分析中，与贝伐珠单抗相比，接受西妥昔单抗治疗的左侧 RAS WT 患者获得了 0.47 个 QALYs 的额外收益，ICER 为 5187.23 美元/QALY（3166.23 美元/LY）。单因素敏感性分析表明，最具影响力的参数是西妥昔单抗的成本。概率敏感性分析表明，在支付意愿阈值为 24081 美元的情况下，西妥昔单抗组的成本效益概率为 92.8%。
在中国左侧 RAS WT mCRC 患者中，FOLFIRI 加西妥昔单抗治疗可能比 FOLFIRI 加贝伐珠单抗治疗更能改善健康结果，并更有效地利用财政资源。
