Cost Effectiveness Varies in TAS-102 Plus Bevacizumab Third Line Treatment

The cost-effectiveness of trifluridine/tipiracil (TAS-102) plus bevacizumab, used in the treatment of colorectal cancer (CRC), varies across multiple countries, according to a study published in Therapeutic Advances in Gastroenterology.¹ The study compared cost effectiveness of the third line treatment in the US, the UK, and China.

CRC is the second leading cause of death from cancer in the world, with new diagnoses of CRC numbering more than 1 million per year.² Metastatic CRC (mCRC) can be treated in a variety of methods, including the use of TAS-102 monotherapy, but survival remains poor in these patients. However, the practical use of TAS-102 has not been explored through a cost effectiveness lens. This study aimed to evaluate the cost effectiveness of using TAS-102 both with and without bevacizumab as a third line treatment for patients with mCRC living in the US, UK, and China.

This study included simulated patients with mCRC who had received 1 to 2 previous chemotherapy or targeted therapy treatment regimens. All participants were randomized into a 1:1 ratio to receive either TAS-102 monotherapy or TAS-102 with bevacizumab. Patients were given best supportive care if they had progressive disease (PD) or intolerable toxicity. A decision model was used to estimate survival and used progression-free survival (PFS), mortality, and PD as health states.

Utility and cost were both measured for patients. Cost data came from the CMS and similar sources for US drug prices, the Monthly Index of Medical Specialties for the UK, and the Xiangya Hospital of Central South University for China. Utility scores were collected from a previously published article on refractory mCRC. The overall costs, incremental cost-effectiveness ratios (ICERs), expected life years (LYs), and quality-adjusted life years (QALYs) were the primary outcomes of this study, with ICERs calculated by calculating the incremental cost divided by incremental QALYs and then compared with a willingness-to-pay (WTP) threshold based on the country.

TAS-102 plus bevacizumab was not cost effective for patients with mCRC in all countries | Image credit: joyfotoliakid - stock.adobe.com

There were 492 mCRC patients in this study, of which 92.1% had received 2 regiments in the past and 2.6% of whom had received 3 or more regiments. Results generated from the decision model found that the United States, China, and the United Kingdom had 1.37, 1.50, and 1.36 QALYs on the TAS-102 plus bevacizumab compared with 0.98, 1.09, and 0.97 QALYs on the monotherapy, respectively. The cost of TAS-102 plus bevacizumab treatment was $304,168, $18,786, and $47,279 in the US, China, and the UK compared with $152,694, $10,190, and $20,484 for the monotherapy.

The ICER was $388,171/QALY ($253,487 per year in the US and $69,617/QALYs in the UK; both were above the WTP thresholds. The ICER in China was $20,919/QALY ($17,635 per year), which was lower than the WTP threshold. The negative incremental net monetary benefits were –$92,974 in the US, –$2094 in the United Kingdom, and $6842 in China, with the US and UK’s values above the WTP threshold. Incremental net health benefits were also lower in the US (–0.62 QALYs) and UK (–0.03 QALYs) compared with China (0.18 QALYs).

There are some limitations to this study. The simulation model was taken from clinical trial data and could be uncertain. The costs of adverse events outside of grade 3 or above were not considered which could have affected the results. The utility values were not outlined in the SUNLIGHT trial and needed to be resourced elsewhere. Survival curves were not reported.

The researchers concluded that, although treating patients with mCRC using TAS-102 plus bevacizumab is cost-effective for the Chinese health care system, it was not cost effective for either the US or the UK. These results can help both health care workers and patients choose the correct form of treatment for them in all countries.

References

1. Zhu Y, Liu K, Zhu H. TAS-102 with or without bevacizumab treatment for patients with metastatic colorectal cancer: a multi-country cost-effectiveness analysis. Ther Adv Gastroenterol. 2024;17:1-13. doi:10.1177/17562848241284998
2. Colorectal cancer: key facts. World Health Organization. July 11, 2023. Accessed October 8, 2024. https://www.who.int/news-room/fact-sheets/detail/colorectal-cancer