Adverse event costs of systemic therapies for metastatic colorectal cancer previously treated with fluoropyrimidine-, oxaliplatin- and irinotecan-based chemotherapy and biologics in the US
Publication: Journal of Comparative Effectiveness Research
Abstract
Aim: The objective of this study was to compare adverse event (AE) management costs for fruquintinib, regorafenib, trifluridine/tipiracil (T/T) and trifluridine/tipiracil+bevacizumab (T/T+bev) for patients with metastatic colorectal cancer (mCRC) previously treated with at least two prior lines of therapy from the US commercial and Medicare payer perspectives. Materials & methods: A cost-consequence model was developed to calculate the per-patient and per-patient-per-month (PPPM) AE costs using rates of grade 3/4 AEs with incidence ≥5% in clinical trials, event-specific management costs and duration treatment. Anchored comparisons of AE costs were calculated using a difference-in-differences approach with best supportive care (BSC) as a common reference. AE rates and treatment duration were obtained from clinical trials: FRESCO and FRESCO-2 (fruquintinib), RECOURSE (T/T), CORRECT (regorafenib) and SUNLIGHT (T/T, T/T+bev). AE management costs for the commercial and Medicare perspectives were obtained from publicly available sources. Results: From the commercial perspective, the AE costs (presented as per-patient, PPPM) were: $4015, $1091 for fruquintinib (FRESCO); $4253, $1390 for fruquintinib (FRESCO-2); $17,110, $11,104 for T/T (RECOURSE); $9851, $4691 for T/T (SUNLIGHT); $8199, $4823 for regorafenib; and $11,620, $2324 for T/T+bev. These results were consistent in anchored comparisons: the difference-in-difference for fruquintinib based on FRESCO was -$1929 versus regorafenib and -$11,427 versus T/T; for fruquintinib based on FRESCO-2 was -$2257 versus regorafenib and -$11,756 versus T/T. Across all analyses, results were consistent from the Medicare perspective. Conclusion: Fruquintinib was associated with lower AE management costs compared with regorafenib, T/T and T/T+bev for patients with previously treated mCRC. This evidence has direct implications for treatment, formulary and pathways decision-making in this patient population.
Plain language summary
What is this article about?
Fruquintinib, regorafenib, trifluridine/tipiracil (T/T) and trifluridine/tipiracil plus bevacizumab (T/T+bev) have demonstrated survival benefits versus best supportive care for the treatment of metastatic colorectal cancer (mCRC) that has progressed following prior lines of therapy. However, there is limited evidence on their relative safety profiles and respective adverse event (AE)-related cost burden. This study estimates the costs of grade 3/4 AEs related to these therapies based on clinical trial data.
What were the results?
The analysis found that fruquintinib was associated with a lower cost of managing AEs compared with the other therapies in previously treated patients with mCRC. A key cost-driver is the management of grade 3/4 hematologic AEs, which had the highest reported rates with T/T and T/T+bev compared with regorafenib or fruquintinib.
What do the results mean?
The cost implications of AEs associated with different treatments should be considered during treatment selection and formulary decision-making.
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Received: 15 May 2024
Accepted: 19 June 2024
Published online: 8 July 2024
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Adverse event costs of systemic therapies for metastatic colorectal cancer previously treated with fluoropyrimidine-, oxaliplatin- and irinotecan-based chemotherapy and biologics in the US. (2024) Journal of Comparative Effectiveness Research. DOI: 10.57264/cer-2024-0084
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