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      Cost-effectiveness of adjuvant FOLFOX and 5FU/LV chemotherapy for patients with stage II colon cancer

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      Author(s)
      Ayvaci, M.U.S.
      Shi J.
      Alagoz O.
      Lubner, S.J.
      Date
      2013
      Source Title
      Medical Decision Making
      Print ISSN
      0272989X
      Volume
      33
      Issue
      4
      Pages
      521 - 532
      Language
      English
      Type
      Article
      Item Usage Stats
      156
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      100
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      Abstract
      Purpose. We evaluated the cost-effectiveness of adjuvant chemotherapy using 5-fluorouracil, leucovorin (5FU/LV), and oxaliplatin (FOLFOX) compared with 5FU/LV alone and 5FU/LV compared with observation alone for patients who had resected stage II colon cancer. Methods. We developed 2 Markov models to represent the adjuvant chemotherapy and follow-up periods and a single Markov model to represent the observation group. We used calibration to estimate the transition probabilities among different toxicity levels. The base case considered 60-year-old patients who had undergone an uncomplicated hemicolectomy for stage II colon cancer and were medically fit to receive 6 months of adjuvant chemotherapy. We measured health outcomes in quality-adjusted life-years (QALYs) and estimated costs using 2007 US dollars. Results. In the base case, adjuvant chemotherapy of the FOLFOX regimen had an incremental cost-effectiveness ratio (ICER) of $54,359/QALY compared with the 5FU/LV regimen, and the 5FU/LV regimen had an ICER of $14,584/QALY compared with the observation group from the third-party payer perspective. The ICER values were most sensitive to 5-year relapse probability, cost of adjuvant chemotherapy, and the discount rate for the FOLFOX arm, whereas the ICER value of 5FU/LV was most sensitive to the 5-year relapse probability, 5-year survival probability, and the relapse cost. The probabilistic sensitivity analysis indicates that the ICER of 5FU/LV is less than $50,000/QALY with a probability of 99.62%, and the ICER of FOLFOX as compared with 5FU/LV is less than $50,000/QALY and $100,000/QALY with a probability of 44.48% and 97.24%, respectively. Conclusion. Although adjuvant chemotherapy with 5FU/LV is cost-effective at all ages for patients who have undergone an uncomplicated hemicolectomy for stage II colon cancer, FOLFOX is not likely to be cost-effective as compared with 5FU/LV.
      Keywords
      calibration
      colon cancer
      cost-effectiveness
      Markov model
      stage II
      antineoplastic agent
      fluorouracil
      folinic acid
      platinum complex
      antineoplastic agent
      fluorouracil
      folinic acid
      adjuvant chemotherapy
      article
      calibration
      colon cancer
      colon tumor
      cost benefit analysis
      cost-effectiveness
      human
      markov model
      multimodality cancer therapy
      probability
      quality adjusted life year
      stage II
      survival rate
      Colonic Neoplasms
      calibration
      colon cancer
      cost-effectiveness
      Markov model
      stage II
      Antineoplastic Combined Chemotherapy Protocols
      Chemotherapy, Adjuvant
      Colonic Neoplasms
      Combined Modality Therapy
      Cost-Benefit Analysis
      Fluorouracil
      Humans
      Leucovorin
      Markov Chains
      Organoplatinum Compounds
      Probability
      Quality-Adjusted Life Years
      Survival Rate
      Antineoplastic Combined Chemotherapy Protocols
      Chemotherapy, Adjuvant
      Colonic Neoplasms
      Combined Modality Therapy
      Cost-Benefit Analysis
      Fluorouracil
      Humans
      Leucovorin
      Markov Chains
      Organoplatinum Compounds
      Probability
      Quality-Adjusted Life Years
      Survival Rate
      Permalink
      http://hdl.handle.net/11693/20989
      Published Version (Please cite this version)
      http://dx.doi.org/10.1177/0272989X12470755
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      • Department of Industrial Engineering 702
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