Cost-Effectiveness Analysis of Regorafenib for Metastatic Colorectal Cancer
Cost-Effectiveness Analysis of Regorafenib for Metastatic Colorectal Cancer
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DOI：
10.1200/jco.2015.61.9569
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发表时间：
2015-11-10
影响因子：
45.3
通讯作者：
Flowers, Christopher R.
中科院分区：
文献类型：
--
作者：
Goldstein, Daniel A.;Ahmad, Bilal B.;Flowers, Christopher R.
瑞戈非尼是治疗难治性转移性结直肠癌的标准治疗选择，与安慰剂相比，中位总生存期延长6周。鉴于这一小增量的临床效益，我们评估了瑞格非尼的成本效益在三线设置为转移性结直肠癌患者从美国payerperspective.MethodsWe开发了一个马尔可夫模型，比较瑞格非尼的成本和效果与安慰剂在三线治疗转移性结直肠癌。健康结果以生命年和质量调整生命年（QHMS）来衡量。药品费用是基于2014年的医疗保险报销率。模型稳健性在单变量和概率敏感性analysis.ResultsRegorafenib提供了额外的0.04 QALY（0.13生命年）的成本为40,000美元，导致增量成本效益比为900,000美元每QALY。在我们所有的单变量和概率敏感性analysis.ConclusionRegorafenib的增量成本-效果比为每QALY> 550，000美元提供了最小的增量效益在高增量成本每QALY在三线转移性结直肠癌的管理。使用基于价值的定价可以提高瑞格非尼的成本效益。(C)2015年美国临床肿瘤学会
PurposeRegorafenib is a standard-care option for treatment-refractory metastatic colorectal cancer that increases median overall survival by 6 weeks compared with placebo. Given this small incremental clinical benefit, we evaluated the cost-effectiveness of regorafenib in the third-line setting for patients with metastatic colorectal cancer from the US payer perspective.MethodsWe developed a Markov model to compare the cost and effectiveness of regorafenib with those of placebo in the third-line treatment of metastatic colorectal cancer. Health outcomes were measured in life-years and quality-adjusted life-years (QALYs). Drug costs were based on Medicare reimbursement rates in 2014. Model robustness was addressed in univariable and probabilistic sensitivity analyses.ResultsRegorafenib provided an additional 0.04 QALYs (0.13 life-years) at a cost of $ 40,000, resulting in an incremental cost-effectiveness ratio of $ 900,000 per QALY. The incremental cost-effectiveness ratio for regorafenib was > $ 550,000 per QALY in all of our univariable and probabilistic sensitivity analyses.ConclusionRegorafenib provides minimal incremental benefit at high incremental cost per QALY in the third-line management of metastatic colorectal cancer. The cost-effectiveness of regorafenib could be improved by the use of value-based pricing. (C) 2015 by American Society of Clinical Oncology