Adverse event costs of systemic therapies for metastatic colorectal cancer previously treated with fluoropyrimidine-, oxaliplati n- and irinotecan-based chemotherapy and biologics in the US

Aim: The objective of this study was to compare adverse event (AE) management costs for fruquintinib, regorafenib, trifluridine / tipiracil (T / T) and trifluridine / tipiracil + bevacizumab (T / T + bev) for patients with metastatic colorectal cancer (mCRC) previously treated with at least two prior lines of therapy from the US commercial and Medicare payer perspectives. Materials & methods: A cost-consequence model was developed to calculate the per-patient and per-patient-per-month (PPPM) AE costs using rates of grade 3 / 4 AEs with incidence >= 5% in clinical trials, event-specific management costs and duration treatment. Anchored comparisons of AE costs were calculated using a difference-in-differences approach with best supportive care (BSC) as a common reference. AE rates and treatment duration were obtained from clinical trials: FRESCO and FRESCO-2 (fruquintinib), RECOURSE (T / T), CORRECT (regorafenib) and SUNLIGHT (T / T, T / T + bev). AE management costs for the commercial and Medicare perspectives were obtained from publicly available sources. Results: From the commercial perspective, the AE costs (presented as perpatient, PPPM) were: $ 4015, $ 1091 for fruquintinib (FRESCO); $ 4253, $ 1390 for fruquintinib (FRESCO-2); $ 17,110, $ 11,104 for T / T (RECOURSE); $ 9851, $ 4691 for T / T (SUNLIGHT); $ 8199, $ 4823 for regorafenib; and $ 11,620, $ 2324 for T / T + bev. These results were consistent in anchored comparisons: the differencein-difference for fruquintinib based on FRESCO was- $ 1929 versus regorafenib and- $ 11,427 versus T / T; for fruquintinib based on FRESCO-2 was- $ 2257 versus regorafenib and- $ 11,756 versus T / T. Across all analyses, results were consistent from the Medicare perspective. Conclusion: Fruquintinib was associated with lower AE management costs compared with regorafenib, T / T and T / T + bev for patients with previously treated mCRC. This evidence has direct implications for treatment, formulary and pathways decision-making in this patient population.