Cost-effectiveness of TAS-102 plus bevacizumab versus TAS-102 monotherapy in patients with metastatic colorectal cancer


Abstract

Background: TAS-102 plus bevacizumab is an anticipated combination regimen for patients who have metastatic colorectal cancer. However, evidence supporting its use for this indication is limited. We compared the cost-effectiveness of TAS-102 plus bevacizumab combination therapy with TAS-102 monotherapy for patients with chemorefractory metastatic colorectal cancer.

Method: Markov decision modeling using treatment costs, disease-free survival, and overall survival was performed to examine the cost-effectiveness of TAS-102 plus bevacizumab combination therapy and TAS-102 monotherapy. The Japanese health care payer''s perspective was adopted. The outcomes were modeled on the basis of published literature. The incremental cost-effectiveness ratio (ICER) between the two treatment regimens was the primary outcome. Sensitivity analysis was performed and the effect of uncertainty on the model parameters were investigated.

Results: TAS-102 plus bevacizumab had an ICER of $21,534 per quality-adjusted life-year (QALY) gained compared with TAS-102 monotherapy. Sensitivity analysis demonstrated that TAS-102 monotherapy was more cost-effective than TAS-102 and bevacizumab combination therapy at a willingness-to-pay of under $50,000 per QALY gained.

Conclusions: TAS-102 and bevacizumab combination therapy is a cost-effective option for patients who have metastatic colorectal cancer in the Japanese health care system.

Keywords: Bevacizumab; Colorectal cancer; Cost-effectiveness; TAS-102.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Markov model diagrams for patients undergoing monotherapy and combination therapy. Five health states exist: stable disease (SD), treatment complication (TC), progression, progression with complication (PC) and death. Each circles represents different health states. Patients in the model move between the health states following the direction of the arrow and assigned transition-probabilities for every model-cycle. Circular arrows indicate transition-probability for remaining in the same state for the next model-cycle. Death is the absorbing state
Fig. 2
Fig. 2
Tornado diagram for deterministic sensitivity analysis. Plot shows the range in incremental cost-effectiveness ratio (ICER) when each variables is tested between at the maximum and the minimum values. Variables to which ICER were not sensitive are not shown
Fig. 3
Fig. 3
Probabilistic sensitivity analysis. Plot of incremental quality-adjusted life-years (QALYs) versus incremental cost from 1000 re-samplings varying all model parameters with probability distributions
Fig. 4
Fig. 4
Cost-effectiveness acceptability curve for probabilistic sensitivity analyses. Plot of the probability of cost-effectiveness for TAS-102 monotherapy and TAS-102 plus bevacizumab combination therapy versus different willingness-to-pay values
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