Cost-effectiveness of adjuvant FOLFOX and 5FU/LV chemotherapy for patients with stage II colon cancer
Date
2013Source Title
Medical Decision Making
Print ISSN
0272989X
Volume
33
Issue
4
Pages
521 - 532
Language
English
Type
ArticleItem 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
calibrationcolon 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/11693/20989Published Version (Please cite this version)
http://dx.doi.org/10.1177/0272989X12470755Collections
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