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

Jiayun Zhong,1 Yu Liu,2 Qian Fu,1 Dan Huang,2 Wenjun Gong,2 Jian Zou2 1Department of Pharmaceutical, the People’s Hospital of Pengzhou, Chengdu, Sichuan, 611930, People’s Republic of China; 2Department of Clinical Pharmacy, the People’s Hospital of Pengzhou, Chengdu, Sichuan, 611930, People’s Republic of ChinaCorrespondence: Jian Zou, Department of clinical pharmacy, the People’s Hospital of Pengzhou, Chengdu, Sichuan, 611930, People’s Republic of China, Tel +86 28 86239898, Email 70336641@qq.comBackground: Regorafenib, a novel multikinase inhibitor, has been approved by the US Food and Drug Administration as a standard treatment choice for metastatic colorectal cancer (mCRC). Nonetheless, its substantial cost places a significant burden on social health resources and patients. However, the cost-effectiveness (CE) of regorafenib compared to other third-line therapies is still undetermined.Objective: This study aims to assess the CE of regorafenib compared to other third-line therapies for the treatment of mCRC.Methods: We conducted a comprehensive literature search in PubMed, Medline, Scopus, Embase, Cochrane Library, as well as nine other databases to identify relevant studies published up to October 2023, focusing on patients with mCRC and examining the cost-effectiveness of regorafenib. Following the screening and extraction of pertinent data, the study quality was assessed using the Quality of Health Economic Studies (QHES) checklist.Results: The literature search yielded 751 records, and after applying the inclusion criteria, 13 studies from 7 different countries were included. Of these, 7 studies evaluated the cost-effectiveness of regorafenib compared to trifluridine/tipiracil (TAS-102), 3 studies compared regorafenib with best supportive care (BSC), and 3 studies compared regorafenib with fruquintinib, serplulimab, and regorafenib dose optimization (ReDo).The quality of the included studies was high with an average QHES scores of 85.62. Regorafenib standard dose proves to be less cost-effective than alternative third-line therapies. Implementing a dose optimization strategy could potentially rectify this disparity and enhance the cost-effectiveness of regorafenib.Conclusion: The use of the standard dose of regorafenib is generally regarded as not cost-effective when compared to other third-line therapies for patients with mCRC. However, implementing a dose-escalation strategy may enhance regorafenib’s cost-effectiveness. Consequently, significant price reductions or optimizing the dose of regorafenib are required to achieve cost-effectiveness.Keywords: regorafenib, metastatic colorectal cancer, cost-effectiveness, incremental cost-effectiveness ratios