The cost-effectiveness analysis of serplulimab versus regorafenib for treating previously treated unresectable or metastatic microsatellite instability-high or deficient mismatch repair colorectal cancer in China

Abstract

ObjectiveThe aim of this study was to investigate the cost-effectiveness of serplulimab versus regorafenib in previously treated unresectable or metastatic microsatellite instability-high (MSI-H)/deficient mismatch repair (dMMR) colorectal cancer in China.MethodsFrom the perspective of China’s health-care system, a Markov model with three health states (progression free, progression, death) was developed for estimating the costs and health outcomes of serplulimab and regorafenib. Data for unanchored matching-adjusted indirect comparison (MAIC), standard parametric survival analysis, the mixed cure model, and transition probabilities calculation were obtained from clinical trials (ASTRUM-010 and CONCUR). Health-care resource utilization and costs were derived from government-published data and expert interviews. Utilities used to calculate quality-adjusted life years (QALYs) were obtained from clinical trials and literature reviews. The primary outcome was the incremental cost-effectiveness ratio (ICER) expressed as cost/QALY gained. Four scenarios were considered in scenario analysis: (a) using original survival data without conducting MAIC; (b) limiting the time horizon to the follow-up time of the clinical trial of serplulimab; (c) adopting a fourfold increase in the risk of death; and (d) applying utilities from two other sources. One-way sensitivity analysis and probabilistic sensitivity analysis were also performed to assess the uncertainty of the results.ResultsIn the base-case analysis, serplulimab provided 6.00 QALYs at a cost of $68,722, whereas regorafenib provided 0.69 QALYs at a cost of $40,106. Compared with that for treatment with regorafenib, the ICER for treatment with serplulimab was $5,386/QALY, which was significantly lower than the triple GDP per capita of China in 2021 ($30,036), which was the threshold used to define the cost-effectiveness. In the scenario analysis, the ICERs were $6,369/QALY, $20,613/QALY, $6,037/QALY, $4,783/QALY, and $6,167/QALY, respectively. In the probabilistic sensitivity analysis, the probability of serplulimab being cost-effective was 100% at the threshold of $30,036/QALY.ConclusionCompared with regorafenib, serplulimab is a cost-effective treatment for patients with previously treated unresectable or metastatic MSI-H/dMMR colorectal cancer in China.

Cost-Effectiveness Analysis of Regorafenib versus Other Third-Line Treatments for Metastatic Colorectal Cancer

“…Their study findings indicated that fruquintinib is the more cost-effective option, as it is associated with an increase of approximately 0.05 quality-adjusted life years (QALYs) and results in a cost saving of about $11,454. Ma Y et al 18 developed a three-state Markov model to estimate the costs and health outcomes of serplulimab and regorafenib in China. They concluded that serplulimab is more cost-effective than regorafenib for patients with previously treated metastatic colorectal cancer (mCRC) in China.…”

“…As shown in Table 5 , most studies (11 out of 13) performed a sensitivity analysis to evaluate the uncertainty and robustness of the model, of which three studies adopted one-way and probabilistic sensitivity analyses 15 , 17 , 24 Three studies conducted univariate and probabilistic sensitivity analyses 14 , 16 , 19 Two studies used scenario analysis based on one-way and probabilistic sensitivity analyses; 18 , 20 one study used scenario analysis based on univariate and probabilistic sensitivity analyses, 13 the rest employed one-way sensitivity analyses and probabilistic sensitivity analyses, respectively. 23 , 25 The sensitivity analysis results revealed that drug prices, baseline utility value, and exposure to regorafenib exerted the most significant influence on the ICER.…”

“… Goldstein DA et al (2015) 14 Univariate and probabilistic sensitivity analyses Regorafenib provides minimal incremental benefit at high incremental cost per QALY The limitation of data availability, and lack of efficacy data to support dosing strategy Kimura M et al (2016) 21 NA TAS-102 is more cost-effective than regorafenib The study did not take quality of life into account, it was not possible to accurately determine the CE in the common units ¥/QALI. Giuliani J et al (2021) 22 NA Regorafenib escalation-dose strategy is more cost-effective than TAS-102 NA Gourzoulidis G et al (2021) 24 One-way and probabilistic sensitivity analyses Regorafenib is less cost-effective than TAS-102 Lack of local data and direct clinical evidence Ma Y et al (2023) 18 One-way and probability sensitivity analysis, scenario analysis Regorafenib is less cost-effective than serplulimab in patients with previously treated mCRC in China Lack of appropriate comparator; 2) The increased risk of death and other parameters were derived based on expert opinion might involve uncertainty. Zhang S et al (2020) 19 Univariate and probabilistic sensitivity analyses Regorafenib is not cost-effective at the WTP threshold of $27,576 when compared with placebo group.…”

“…As indicated in Table 1, these 13 studies were from seven different countries, four studies were conducted in the US, [13][14][15][16] three studies were from China, [17][18][19] two studies were from Japan 20,21 and the rest were from Italy, 22 England and Wales, 23 and the Czech. 25 The most commonly adopted perspective in the reviewed economic evaluation was the payer perspective; of the nine studies with the perspective of governmental healthcare, one used the third-party payer perspective.…”