Background: Survival benefit of regorafenib and fruquintinib as third-line agents have been respectively demonstrated in patients with treatment-refractory metastatic colorectal cancer. This study tries to explore the cost-effectiveness of the two agents. Methods: A Markov model was performed based on two phase 3 trials, FRESCO and CONCUR. Health outcomes were measured with quality-adjusted life-years (QALYs). The key outcome was incremental cost-effectiveness ratio (ICER). Probabilistic sensitivity and one-way sensitivity analysis were performed to estimate the impact of essential variables on the results of the analysis. Results: No statistical differences were observed in the baseline patient characteristics, except that the CONCUR trial enrolled older patients and higher ratios of prior use of VEGF or EGFR antibodies in comparison with the FRESCO trial.Treatment with fruquintinib was estimated to cost $25,550.15 with an effectiveness gain of 0.54 QALYs, whereas regorafenib resulted in 0.53 QALY at a mean cost of $29,681.52, yielding ICER of $-413,137.00 per QALY. By using treble the Chinese Gross Domestic Product per Capita as willingness-to-pay threshold, the probability for fruquintinib being cost-effective was higher than regorafenib in the probabilistic sensitivity analysis. Conclusions: Fruquintinib provides a more cost-effective option for metastatic colorectal patients compared with regorafenib in the third line treatment.

AE: adverse event; BSC : best supportive care; PFS: progression-free survival; PD: progressive disease; ICER: incremental cost-effectiveness ratio; QALY: quality-adjusted life year; USD: United States dollar.