title: Cost-Effectiveness Analysis of Regorafenib for Metastatic Colorectal Cancer.
abstract: OBJECTIVE
  Regorafenib 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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  Regorafenib 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.
  
  
  CONCLUSIONS
  Regorafenib 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.
authors: Daniel A. Goldstein, Bilal B. Ahmad, David H. Howard, Joseph Lipscomb, Bassel F. El-Rayes, and Christopher R. Flowers, Emory University; and Qiushi Chen and Turgay Ayer, Georgia Institute of Technology, Atlanta, GA. dgolds8@emory.edu.
authors: Daniel A
authors: DA
authors: Goldstein
authors: Daniel A. Goldstein, Bilal B. Ahmad, David H. Howard, Joseph Lipscomb, Bassel F. El-Rayes, and Christopher R. Flowers, Emory University; and Qiushi Chen and Turgay Ayer, Georgia Institute of Technology, Atlanta, GA.
authors: Bilal B
authors: BB
authors: Ahmad
authors: Daniel A. Goldstein, Bilal B. Ahmad, David H. Howard, Joseph Lipscomb, Bassel F. El-Rayes, and Christopher R. Flowers, Emory University; and Qiushi Chen and Turgay Ayer, Georgia Institute of Technology, Atlanta, GA.
authors: Qiushi
authors: Q
authors: Chen
authors: Daniel A. Goldstein, Bilal B. Ahmad, David H. Howard, Joseph Lipscomb, Bassel F. El-Rayes, and Christopher R. Flowers, Emory University; and Qiushi Chen and Turgay Ayer, Georgia Institute of Technology, Atlanta, GA.
authors: Turgay
authors: T
authors: Ayer
authors: Daniel A. Goldstein, Bilal B. Ahmad, David H. Howard, Joseph Lipscomb, Bassel F. El-Rayes, and Christopher R. Flowers, Emory University; and Qiushi Chen and Turgay Ayer, Georgia Institute of Technology, Atlanta, GA.
authors: David H
authors: DH
authors: Howard
authors: Daniel A. Goldstein, Bilal B. Ahmad, David H. Howard, Joseph Lipscomb, Bassel F. El-Rayes, and Christopher R. Flowers, Emory University; and Qiushi Chen and Turgay Ayer, Georgia Institute of Technology, Atlanta, GA.
authors: Joseph
authors: J
authors: Lipscomb
authors: Daniel A. Goldstein, Bilal B. Ahmad, David H. Howard, Joseph Lipscomb, Bassel F. El-Rayes, and Christopher R. Flowers, Emory University; and Qiushi Chen and Turgay Ayer, Georgia Institute of Technology, Atlanta, GA.
authors: Bassel F
authors: BF
authors: El-Rayes
authors: Daniel A. Goldstein, Bilal B. Ahmad, David H. Howard, Joseph Lipscomb, Bassel F. El-Rayes, and Christopher R. Flowers, Emory University; and Qiushi Chen and Turgay Ayer, Georgia Institute of Technology, Atlanta, GA.
authors: Christopher R
authors: CR
authors: Flowers
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use*; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000191:economics*; D018849:Controlled Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D006278:Medicare; D008875:Middle Aged; D010671:Phenylurea Compounds / Q000191:economics* / Q000627:therapeutic use*; D011725:Pyridines / Q000191:economics* / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D014481:United States
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D011725:Pyridines; C559147:regorafenib