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

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 ۱,۰۰۰ 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 ۵% was applied to both costs and outcomes. Data analysis utilized Microsoft Excel, R version ۴.۱.۳, and TreeAge Pro Healthcare version ۲۰۲۲ software, with the significance threshold set at ۰.۰۵.Results: The base-case analysis revealed that regorafenib offers a cost saving of ۱۲,۱۵۴ and an incremental gain of ۰.۱ quality-adjusted life years per patient over a ۱۹-month horizon compared with the CetIri regimen. Probabilistic sensitivity analysis showed a greater than ۹۹% 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