Cost-Effectiveness Analysis of First-Line Cetuximab Plus Leucovorin, Fluorouracil, and Oxaliplatin (FOLFOX-4) versus FOLFOX-4 in Patients with RAS Wild-Type Metastatic Colorectal Cancer

Figures & data

Figure 1 Markov model for RAS wide-type metastatic colorectal cancer.

Notes: A Markov model containing three health states (progression-free state, progressive disease, and death) was conducted.

Table 1 Clinical Efficacy and Grade 3–4 AEs

Variables	Cetuximab+FOLFOX-4	FOLFOX-4
Clinical efficacy, months (95% CI)
Median PFS (m)	9.2 (7.7–9.4)	7.4 (5.6–7.9)
Median OS (m)	20.7 (15.9–22.1)	17.8 (14.9–19.6)
Grades 3–4 AEs (%)
Neutropenia	61.9	43.2
Leukopenia	26.8	21.1
Fatigue	12.9	9.5
Hypokalemia	10.3	4.0
Thrombocytopenia	10.3	6.5
Hypomagnesemia	8.2	1.0
Dermatitis acneiform	7.2	0
Stomatitis	6.2	0.5
Diarrhea	5.7	2.0
Bone marrow failure	4.6	6.0
Any skin reactions	25.8	0

Abbreviations: AEs, adverse events; FOLFOX-4, leucovorin, fluorouracil, and oxaliplatin; OS, overall survival; PFS, progression-free survival.

Table 2 Cost ($) and Utility Scores of Cetuximab Plus FOLFOX-4 and FOLFOX-4

Variables	Cetuximab+FOLFOX-4	FOLFOX-4
Cost for PFS state ($/month)
Chemotherapy drugs	263	276
Cetuximab	2,517	0
Test	238	238
Grade ≥ 3 AEs	59	40
Inpatient fees	123	92
Time	41	20
Travel	286	214
Total cost for PFS state	3,527	880
Cost for PD state ($/month)
Chemotherapy drugs	567	1,061
Additional cost for PD state	257	344
Total cost for PD state	824	1,405

Abbreviations: FOLFOX-4, leucovorin, fluorouracil, and oxaliplatin; PFS, progression-free survival; PD, progressive disease.

Table 3 Results of Cost-Effectiveness Analysis

Variables	Cetuximab+FOLFOX-4	FOLFOX-4
Cost ($)
PFS state	30,825	6,372
PD state	9,175	14,549
Total cost	40,000	20,921
Incremental cost	19,079
Effectiveness (QALYs)
PFS state	0.62	0.51
PD state	0.63	0.59
Total effectiveness	1.25	1.10
Incremental effectiveness	0.15
ICER ($/QALY)	127,193

Abbreviations: FOLFOX-4, leucovorin, fluorouracil, and oxaliplatin; PFS, progression-free survival; PD, progressive disease; QALYs, quality adjusted-life years; ICER, incremental cost-effectiveness ratio.

Figure 2 Tornado diagram of the one-way sensitivity analysis.

Notes: The tornado diagram showed the results of the one-way sensitivity analysis to observe the effect of different parameters on the Markov model. The parameters are arranged in descending order in terms of trend with the degree of influence on the Markov model.

Abbreviations: FOLFOX-4, leucovorin, fluorouracil, and oxaliplatin; combination arm, cetuximab plus FOLFOX-4 arm; PFS, progression-free survival; PD, progressive disease; QALM, quality adjusted-life month; ICER, incremental cost-effectiveness ratio.

Figure 3 Cost-effectiveness acceptability curves.

Notes: The curves show the results of probabilistic sensitivity analysis to determine the optimal strategy under the premise of varying willingness-to-pay thresholds.

Abbreviations: FOLFOX-4, leucovorin, fluorouracil, and oxaliplatin; CE, cost-effectiveness; QALM, quality-adjusted life month.