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Health Economic Models for Metastatic Colorectal Cancer: A Methodological Review

  • Systematic Review
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Abstract

Objective

The aim of this systematic review was to provide a comprehensive and detailed review of structural and methodological assumptions in model-based cost-effectiveness analyses of systemic metastatic colorectal cancer (mCRC) treatments, and discuss their potential impact on health economic outcome estimates.

Methods

Five databases (EMBASE, MEDLINE, Cochrane Library, Health Technology Assessment and National Health Service Health Economic Evaluation Database) were searched on 26 August 2019 for model-based full health economic evaluations of systemic mCRC treatment using a combination of free-text terms and subject headings. Full-text publications in English were eligible for inclusion if they were published in or after the year 2000. The Consolidated Health Economic Evaluation Reporting Standards checklist was used to assess the reporting quality of included publications. Study selection, appraisal and data extraction were performed by two reviewers independently.

Results

The search yielded 1418 publications, of which 54 were included, representing 51 unique studies. Most studies focused on first-line treatment (n = 29, 57%), followed by third-line treatment (n = 13, 25%). Model structures were health-state driven (n = 27, 53%), treatment driven (n = 19, 37%), or a combination (n = 5, 10%). Cohort-level state-transition modelling (STM) was the most common technique (n = 33, 65%), followed by patient-level STM and partitioned survival analysis (both n = 6, 12%). Only 15 studies (29%) reported some sort of model validation. Health economic outcomes for specific strategies differed substantially between studies. For example, survival following first-line treatment with fluorouracil, leucovorin and oxaliplatin ranged from 1.21 to 7.33 years, with treatment costs ranging from US$8125 to US$126,606.

Conclusions

Model-based cost-effectiveness analyses of systemic mCRC treatments have adopted varied modelling methods and structures, resulting in substantially different outcomes. As models generally focus on first-line treatment without consideration of downstream treatments, there is a profound source of structural uncertainty implying that the cost-effectiveness of treatments across the mCRC pathway remains uncertain.

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Data Availability Statement

All data generated or analysed during this study are included in this published article (and its supplementary information files).

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Acknowledgements

The authors would like to thank Lindy Cochrane, Liaison Librarian, Nursing, Health Sciences, Population and Global Health at the University of Melbourne, for critically reviewing and advising on the selection of databases and search strategy.

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Authors and Affiliations

  1. Cancer Health Services Research, Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia

    Koen Degeling, Martin Vu & Maarten IJzerman

  2. Cancer Health Services Research, Centre for Health Policy, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia

    Koen Degeling, Martin Vu & Maarten IJzerman

  3. Health Technology and Services Research, Technical Medical Centre, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, The Netherlands

    Hendrik Koffijberg & Maarten IJzerman

  4. Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia

    Hui-Li Wong & Peter Gibbs

  5. Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia

    Hui-Li Wong & Maarten IJzerman

  6. Department of Medical Oncology, University Medical Centre Utrecht and Utrecht University, Utrecht, The Netherlands

    Miriam Koopman

  7. Department of Medical Oncology, Western Health, Melbourne, Australia

    Peter Gibbs

Authors
  1. Koen Degeling
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  2. Martin Vu
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  3. Hendrik Koffijberg
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  4. Hui-Li Wong
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  5. Miriam Koopman
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  6. Peter Gibbs
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  7. Maarten IJzerman
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Contributions

All authors contributed to the study conception and design. The search strategy was prepared by KD, MV and MIJ, and critically reviewed and approved by all other authors. The selection process and data extraction were performed by KD and MV. All authors contributed to the interpretation and discussion of the results. The first draft of the manuscript was prepared by KD, and critically reviewed by all other authors. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Koen Degeling.

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Funding

No funding was received for performing this study.

Conflicts of interest

Authors KD, HK, MK and MIJ acknowledge authorship on several publications that were included in the analysis. MK is advisor to The Netherlands Organisation for Health Research and Development, a member of the scientific board of the Dutch Cancer Society (KWF), chair of the Dutch Colorectal Cancer Group (DCCG), principal investigator (PI) for PLCRC (Dutch national observational cohort study), involved in several clinical trials in CRC as PI or co-investigator and declares unrestricted institutional grants from Amgen, Bayer, BMS, Merck-Serono, Nordic Farma, Roche, Servier, Sirtex and Sanofi-Aventis.

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Degeling, K., Vu, M., Koffijberg, H. et al. Health Economic Models for Metastatic Colorectal Cancer: A Methodological Review. PharmacoEconomics 38, 683–713 (2020). https://doi.org/10.1007/s40273-020-00908-4

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  • DOI: https://doi.org/10.1007/s40273-020-00908-4

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