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Zanzalintinib (XL092)

Metastatic colorectal cancer

Manufacturer
Exelixis
Launch
Not announced
Last updated
65 sources

Cost-effectiveness analyses and utility weights

Published cost-effectiveness analyses and health-state utility weights that a model of this product could cite, adapt, or compare against, grouped by how each article relates to the product and its indication. Every value is quoted from the article it cites, and section 3 lists the searches that found the articles.

12 cost-effectiveness analyses and 7 studies reporting utility weights · 13 sources

Overview

ItemDetail
Literature searchedTufts Medical Center Cost-Effectiveness Analysis Registry, searched October 21, 2026; the queries are listed in section 3.
Cost-effectiveness analyses12
Studies reporting utility weights7

Cost-effectiveness analyses

Analyses of Zanzalintinib (XL092)

No evidence found.

Treatments for the same indication

Regorafenib dose optimization versus trifluridine/tipiracil plus bevacizumab and fruquintinib in refractory metastatic colorectal cancer, United States: Bekaii-Saab et al. (2025)

Relevance: Evaluates regorafenib dose optimization against trifluridine/tipiracil plus bevacizumab and against fruquintinib in refractory metastatic colorectal cancer from a United States payer perspective, with regorafenib the active comparator in STELLAR-303.

Access: Free full text

“We evaluated relative cost-effectiveness of these therapies in patients with mCRC from a US payer’s perspective.” (opens the source at this quote in a new tab)

“A partitioned survival model (PSM) was constructed to estimate total costs and quality-adjusted life years (QALYs).” (opens the source at this quote in a new tab)

“The model comprised of three health states: Pre-disease progression, post-disease progression, and death.” (opens the source at this quote in a new tab)

“All outcomes were captured from a US payer perspective with an annual discounting rate of 5% applied to both costs and QALYs.” (opens the source at this quote in a new tab)

“The model used a monthly cycle and a 3-year time horizon.” (opens the source at this quote in a new tab)

“Compared to ReDO, TAS-BEV was associated with an additional 0.197 QALYs at an additional cost of $109,461, resulting in an incremental cost-effectiveness ratio (ICER) of $554,567 per QALY gained.” (opens the source at this quote in a new tab)

“On the other hand, ReDo had a negligible cost difference ($130,821 versus $130,902), when compared with fruquintinib, and a slightly better QALY (0.576 versus 0.517), resulting in ReDO dominant over fruquintinib.” (opens the source at this quote in a new tab)

“Under the conventional willingness-to-pay (WTP) threshold in US ($150,000 per QALY gained), ReDO was cost-effective when compared with TAS-BEV and was dominant over fruquintinib.” (opens the source at this quote in a new tab)

“In patients with prior anti-VEGF therapy, ReDO remained cost-effective compared to TAS-BEV and fruquintinib under the conventional WTP threshold.” (opens the source at this quote in a new tab)

Regorafenib dose optimization versus standard-dose regorafenib, trifluridine/tipiracil, and trifluridine/tipiracil plus bevacizumab in refractory metastatic colorectal cancer, United States: Cho et al. (2022)

Relevance: Evaluates regorafenib dose optimization against standard-dose regorafenib, the comparator regimen in STELLAR-303, and against trifluridine/tipiracil in refractory metastatic colorectal cancer in the United States.

Regorafenib and trifluridine/tipiracil versus best supportive care in refractory metastatic colorectal cancer, United States: Cho et al. (2018)

Relevance: Evaluates regorafenib, the active comparator in STELLAR-303, and trifluridine/tipiracil against best supportive care and against each other in refractory metastatic colorectal cancer in the United States.

Fruquintinib versus placebo in refractory metastatic colorectal cancer, United States: Kang et al. (2025)

Relevance: Evaluates fruquintinib, a later-line VEGFR inhibitor listed in section 2 and studied in FRESCO-2, against placebo in refractory metastatic colorectal cancer in the United States.

“This study evaluates the cost-effectiveness of fruquintinib versus placebo for this patient population from the perspective of US payers.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“We developed a partitioned survival model on the basis of patient-level data reconstructed from the survival curves of the FRESCO-2 trial.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“The time horizon of the model was the patient’s lifetime, defined as 10 years, during which most patients in both groups die.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“We used a discount rate of 3.0% per year for both clinical outcomes and costs.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“Fruquintinib treatment resulted in incremental gains of 0.108 life years (LYs) and 0.073 QALYs compared with the placebo, at an additional cost of US$112,294, primarily driven by medication expenses.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“The ICER for fruquintinib versus placebo was calculated at US$1,037,855 per LY and US$1,546,619 per QALY gained, exceeding the predefined cost-effectiveness threshold.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“In the PSA, the probability of fruquintinib not being cost-effective was 100% at the US$100,000 threshold” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

Trifluridine/tipiracil plus bevacizumab versus trifluridine/tipiracil in refractory metastatic colorectal cancer, United States, United Kingdom, and China: Zhu et al. (2024)

Relevance: Evaluates trifluridine/tipiracil with bevacizumab, an approved treatment alternative listed in section 2, against trifluridine/tipiracil alone in metastatic colorectal cancer in the United States, the United Kingdom, and China.

“A comprehensive Markov model of the 10-year horizon for three health states was established using data from the SUNLIGHT trial to evaluate the cost and health effects of TAS-102 with or without bevacizumab at particular willingness-to-pay (WTP) thresholds” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“In the United States, United Kingdom, and China, the major cost and efficacy outcomes were analyzed with assumed annual discount rates of 3%, 3.5%, and 5%, respectively.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“Treatment with TAS-102 plus bevacizumab versus TAS-102 monotherapy increased effectiveness (cost) by 0.39 ($151,474), 0.38 ($26,794), and 0.41 ($8596) QALYs, with an ICER of $388,171, $69,617, and $20,919 per QALY and an INHB of −0.62, −0.03, and 0.18 QALYs in the United States, United Kingdom, and China, respectively.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“At respective WTP thresholds of $150,000, $65,000, and $37,653 per QALY in the United States, United Kingdom, and China, the odds of TAS-102 plus bevacizumab being the dominant treatment were 0%, 49.6%, and 87.8%, respectively.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“TAS-102 plus bevacizumab treatment represents a cost-effective third-line treatment for refractory mCRC from a Chinese payers’ perspective, although the same was not true in the United States or United Kingdom at current drug prices.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

Regorafenib at three doses versus best supportive care in third-line metastatic colorectal cancer, United States: Goldstein et al. (2015)

Relevance: Evaluates regorafenib, the active comparator in STELLAR-303, at alternative daily doses against best supportive care as third-line therapy for metastatic colorectal cancer from a United States payer perspective.

“To address this issue, we developed a Markov model to evaluate the cost-effectiveness of regorafenib as third-line therapy in patients with mCRC from the perspective of the US payer.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“We performed analyses in the model with three different dosing strategies: 120, 160, and 147 mg daily.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“We did not perform annual discounting of the costs and benefits in this analysis, because the OS rate was 24% at 1 year for both groups.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“On the basis of the dosing strategy used, the incremental cost of a course of treatment with regorafenib was $32,000 (120-mg dosing) to $43,000 (160-mg dosing).” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“The ICER for regorafenib compared with best supportive care was between $730,000 and $980,000 per QALY.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“ICER, $ per QALY 732,242 897,411 975,954” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

“These results demonstrated nearly 0% probability that regorafenib is cost-effective at WTP values < $600,000 per QALY.” (opens the original PMC page at this quote in a new tab)View highlighted excerpt for this quote

Trifluridine/tipiracil and regorafenib versus best supportive care in previously treated metastatic colorectal cancer, England and Wales: Bullement et al. (2018)

Relevance: Evaluates trifluridine/tipiracil and regorafenib against best supportive care and against each other in previously treated metastatic colorectal cancer in England and Wales.

Access: Free full text

“This study investigated the cost-effectiveness of trifluridine/tipiracil and regorafenib relative to BSC alone in patients with mCRC who have been previously treated with, or are not considered candidates for, standard chemotherapies.” (opens the source at this quote in a new tab)

“A partitioned survival model was constructed to assess the lifetime costs and benefits accrued by patients.” (opens the source at this quote in a new tab)

“A 10-year time horizon was used in the model (ie, costs and outcomes for patients were considered up until 10 years after the initiation of treatment).” (opens the source at this quote in a new tab)

“Costs and QALYs were discounted at an annual rate of 3.5%, in line with NICE guidance.” (opens the source at this quote in a new tab)

“Trifluridine/tipiracil was associated with a 0.27 incremental life year versus BSC alone, which corresponds to a 0.17 quality-adjusted life year gain.” (opens the source at this quote in a new tab)

“The incremental cost of treatment with trifluridine/tipiracil was £8,479, resulting in an incremental cost-effectiveness ratio of £51,194 per quality-adjusted life year gained.” (opens the source at this quote in a new tab)

“Compared with BSC alone, regorafenib is associated with a 0.16 LYG, incremental QALY gain of 0.11, and incremental costs of £14,613.” (opens the source at this quote in a new tab)

“Rego vs. BSC £133,561” (opens the source at this quote in a new tab)

“Compared with regorafenib, trifluridine/tipiracil is associated with a 0.10 LYG, incremental QALY gain of 0.06, and a cost saving of £6134, and therefore, trifluridine/tipiracil dominates regorafenib (ie, increased expected benefit for reduced expected cost).” (opens the source at this quote in a new tab)

Regorafenib versus fruquintinib as third-line therapy in metastatic colorectal cancer, China: Guan et al. (2021)

Relevance: Evaluates fruquintinib against regorafenib, the comparator in STELLAR-303, as third-line therapy for metastatic colorectal cancer in China.

Access: Free full text

“A three-state Markov model with monthly cycle was constructed to estimate lifetime incremental cost-effectiveness ratio (ICER) of fruquintinib versus regorafenib as third-line treatment for patients with mCRC from Chinese health care perspective.” (opens the source at this quote in a new tab)

“According to the recommendation of China guideline for pharmacoeconomics evaluation, a discount rate of 5% per annum was used for both cost inputs and health outcomes” (opens the source at this quote in a new tab)

“Survival analysis was applied to calculate transition probabilities using the data from the clinical trials FRESCO and CONCUR, which were also the data sources accessing probabilities of adverse events.” (opens the source at this quote in a new tab)

“Fruquintinib provided 0.74 QALYs at a cost of CNY 151,058 (USD 22,888), whereas regorafenib provided 0.79 QALYs at a cost of CNY 226,657 (USD 32,224).” (opens the source at this quote in a new tab)

“Compared to fruquintinib, the ICER of regorafenib was CNY 1,529,197/QALY (USD 231,697/QALY) from Chinese health care perspective, which was above the triple GDP per capita of China in 2019 (CNY 212,676) (USD 32,224) as the threshold to define the cost-effectiveness.” (opens the source at this quote in a new tab)

“Cost-effectiveness acceptability curves derived from probabilistic sensitivity analysis demonstrated the probability that fruquintinib was more cost-effective was 100% when the threshold was the triple GDP per capita of China.” (opens the source at this quote in a new tab)

Durvalumab plus tremelimumab versus best supportive care in refractory metastatic colorectal cancer, Canada: Ahluwalia et al. (2025)

Relevance: Evaluates durvalumab plus tremelimumab against best supportive care in refractory metastatic colorectal cancer from the Canadian public-payer perspective, the refractory setting in which STELLAR-303 studied zanzalintinib with atezolizumab.

Access: Free full text

The same disease in other populations or settings

Sotorasib plus panitumumab versus standard care in refractory KRAS G12C-mutated colorectal cancer, United States: Liu et al. (2025)

Relevance: Evaluates sotorasib plus panitumumab, a therapy listed in section 2 for the KRAS G12C-mutated subgroup, against trifluridine/tipiracil and regorafenib in refractory metastatic colorectal cancer.

Access: Not open access

Not quoted: The results against trifluridine/tipiracil and against regorafenib separately are reported in the full text, which this page does not quote.

“This study evaluates the cost-effectiveness of sotorasib plus panitumumab in contrast to standard care in the treatment of refractory colorectal cancer (CRC) with mutated KRASG12Cfrom the perspective of healthcare payers in the U.S.A.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“An economic evaluation utilizing a 3-state partitioned survival model assessed the cost-effectiveness of sotorasib plus panitumumab versus standard care.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“The estimated cost for sotorasib plus panitumumab treatment was higher than that of standard care treatment (77,087.936 USD vs 8905.065 USD).” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“In addition, the estimated utility was relatively augmented than that of standard care treatment (0.876 QALYs vs 0.857 QALYs).” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“The ICER was calculated at 3,551,555554USD/ QALY, suggesting the sotorasib plus panitumumab therapy did not demonstrate an economic advantage over standard care therapy for refractory CRC patients with mutated KRASG12C at the threshold of 150,000 USD/ QALY.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

Related diseases and analogous treatments

Lenvatinib plus pembrolizumab versus chemotherapy in recurrent mismatch repair-proficient endometrial cancer after platinum-based therapy, United States: Dioun et al. (2024)

Relevance: Evaluates lenvatinib plus pembrolizumab, the combination LEAP-017 studied in metastatic colorectal cancer (section 2), against chemotherapy in recurrent mismatch repair-proficient endometrial cancer after platinum-based therapy in the United States.

“A Markov model was created to simulate the clinical trajectory of 10,000 patients with recurrent pMMR endometrial cancer.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“The initial decision point in the model was treatment with ether lenvatinib plus pembrolizumab or chemotherapy (doxorubicin or dose-dense paclitaxel).” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“A cycle length of 3 months and a time horizon of 2 years was used.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“The primary outcome was incremental cost-effectiveness ratios (ICERs), expressed in 2020 US dollars/QALYs.” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“Chemotherapy was the least costly strategy at $66,693 followed by lenvatinib plus pembrolizumab ($193,590).” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“Chemotherapy was cost-effective compared with lenvatinib plus pembrolizumab (ICER: $164,493/QALYs).” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

“Lenvatinib plus pembrolizumab became cost-effective when its cost was reduced by $1553 per month (7.8% reduction).” (opens the original PubMed page at this quote in a new tab)View highlighted excerpt for this quote

Nivolumab plus cabozantinib versus sunitinib in first-line advanced renal cell carcinoma, United States: Liao et al. (2021)

Relevance: Evaluates first-line nivolumab plus cabozantinib against sunitinib in advanced renal cell carcinoma from a United States payer perspective.

Utility weights

Utility weights from analyses of Zanzalintinib (XL092)

No evidence found.

Utility weights for the same indication

Utility weights for progression-free and progressed disease and adverse events, refractory metastatic colorectal cancer: Kang et al. (2025)

Relevance: EQ-5D utilities for progression-free and progressed refractory colorectal cancer and disutilities for diarrhea, fatigue, hand-foot syndrome, and abdominal pain in a United States fruquintinib model.

Utility weights for pre-progression and post-progression disease, refractory metastatic colorectal cancer: Bekaii-Saab et al. (2025)

Relevance: Utilities for pre-progression and post-progression refractory metastatic colorectal cancer in a United States model of regorafenib dose optimization, with regorafenib the comparator in STELLAR-303.

Access: Free full text

Utility weights for progression-free and progressive disease in the United States, United Kingdom, and China and adverse events by grade, metastatic colorectal cancer: Zhu et al. (2024)

Relevance: Utilities for progression-free and progressive metastatic colorectal cancer, with United States or United Kingdom values and China values, and disutilities by adverse-event grade.

Utility weights for stable and progressive disease and adverse events, refractory metastatic colorectal cancer: Ahluwalia et al. (2025)

Relevance: Utilities for stable and progressive refractory metastatic colorectal cancer and for adverse events, obtained from published literature, in a Canadian model of durvalumab plus tremelimumab.

Access: Free full text

Utility weights for progression-free and post-progression disease and adverse events, metastatic colorectal cancer: Kashiwa and Matsushita (2020)

Relevance: Utilities for progression-free and post-progression metastatic colorectal cancer and for adverse events, extracted from published studies.

Access: Not open access

Not quoted: The utility weights are reported in the full text, which this page does not quote.

Utility weights by treatment received, metastatic colorectal cancer: Bullement et al. (2018)

Relevance: EQ-5D utilities for metastatic colorectal cancer by treatment received: best supportive care, trifluridine/tipiracil, or regorafenib.

Access: Free full text

Utility weights for the same disease in other populations or settings

No evidence found.

Utility weights for related diseases and analogous treatments

No evidence found.

Search strategy

DatasetQueryResults
Ratioszanzalintinib OR XL0920
Methodsivonescimab OR zipalertinib OR zanzalintinib1
Ratiossotorasib OR adagrasib6
Ratiosregorafenib46
Ratiosfruquintinib5
Ratiostrifluridine OR "TAS-102" OR tipiracil31
Ratios"colorectal" AND (refractory OR "third-line")53
Ratios"colorectal" AND "third-line"39
Ratios"colorectal" AND refractory38
Weights"colorectal" AND (refractory OR "third-line" OR "progression-free")240
Weights"hand-foot" AND "colorectal"12
Ratioscabozantinib AND (atezolizumab OR nivolumab)109
Ratioslenvatinib AND pembrolizumab69
Ratios"colorectal" AND (lenvatinib OR atezolizumab OR cobimetinib)0
Ratios"colorectal" AND "microsatellite stable"1
Methods"colorectal" AND (Medicare OR "treatment discontinuation")28