regorafenib versus cetuximab plus irinotecan in third-line metastatic colorectal cancer in iran: a model-based cost-utility analysis

Background: metastatic colorectal cancer (mcrc) constitutes a significant health burden globally, accompanied by elevated mortality rates. this study aimed to assess the cost-effectiveness of regorafenib, an orally administered multi-kinase inhibitor, compared to the combination of cetuximab and irinotecan (cetiri) as third-line therapy for mcrc in iran.method: a model-based cost-utility analysis was conducted employing a semi-markov model for a hypothetical cohort of 1,000 patients, integrating time-dependent transition probabilities. from the perspective of the iranian healthcare payer, the analysis included direct medical costs, such as therapy, monitoring, and adverse effect-related expenses, sourced from national databases in iran. a yearly discount rate of 5% was applied to both costs and outcomes. data analysis utilized microsoft excel, r version 4.1.3, and treeage pro healthcare version 2022 software, with the significance threshold set at 0.05.results: the base-case analysis revealed that regorafenib offers a cost saving of $12,154 and an incremental gain of 0.1 quality-adjusted life years per patient over a 19-month horizon compared with the cetiri regimen. probabilistic sensitivity analysis showed a greater than 99% probability of regorafenib being cost-effective.conclusion: consistent with existing evidence, the findings advocate regorafenib as a cost-effective alternative to cetiri for third-line treatment of mcrc in iran, considering the specific healthcare system context. given the foundational assumptions, caution is advised when extrapolating these results to other regions.