A systematic review of cost-effectiveness studies of later-line treatments for refractory metastatic colorectal cancer

This study aims to conduct a systematic review of cost-effectiveness studies evaluating later-line treatments for refractory metastatic colorectal cancer. This study conducted a literature search using PubMed, Cochrane, and Embase databases. Search terms included keywords related to colorectal cancer, regorafenib, trifluridine–tipiracil, fruquintinib, and cost-effectiveness analysis. Extracted data encompassed cost-effectiveness outcomes, methodological characteristics, and the seven parameters exerting the greatest influence on incremental cost-effectiveness ratio (ICER) results. Among 183 studies screened, a total of 11 studies met the inclusion criteria. Most studies concluded that later-line treatments for refractory metastatic colorectal cancer were not cost-effective compared to best supportive care (BSC). However, trifluridine–tipiracil was found to be cost-effective compared to BSC in some studies, and several studies reported it as a dominant option over regorafenib. Nonetheless, the cost-effectiveness outcomes between trifluridine–tipiracil and regorafenib were inconsistent across studies. Overall, drug costs and health utility values in the progressed disease state were identified as having the greatest impact on ICER outcomes. Later-line treatments were generally not found to be cost-effective compared to BSC, mainly due to high drug costs. No treatment showed consistently favorable results across studies, with outcomes varying by comparator, country, and model settings. PROSPERO (CRD420251243616)