title: Adjuvant therapy for stage III colon cancer: economics returns to research and cost-effectiveness of treatment.
abstract: BACKGROUND
  In 1989, the National Cancer Institute issued a clinical announcement advising physicians of the benefits of combined levamisole and fluorouracil as an adjuvant treatment for patients with stage III colon cancer.
  
  
  OBJECTIVE
  We have estimated the cost-effectiveness of the combined treatment and estimated the social return on the National Institutes of Health (NIH) research investment that led to this innovative cancer treatment.
  
  
  METHODS
  A computer simulation model, CAN*TROL, was used to estimate costs and benefits for a population cross-section receiving the adjuvant treatment. A method similar to "Q-TWiST" was used to assess the impact of quality-of-life adjustments.
  
  
  RESULTS
  For a typical base-line case, the calculated cost-effectiveness is a very favorable $2094 per year of life saved. Using a variety of less favorable assumptions, cost-effectiveness is still less than $5000 per year of life saved, again a favorable value. Quality-of-life adjustments have a negligible effect on the cost-effectiveness outcome. The net present value of the return to the NIH research investment is estimated to be $1.66 billion.
  
  
  CONCLUSIONS
  Under a wide range of reasonable assumptions, adjuvant therapy for stage III colon cancer appears to be a very cost-effective procedure. The investment in the research that resulted in this therapy promises to yield a high return.
authors.affiliation: Applied Research Branch, National Cancer Institute, Bethesda, MD 20892.
authors.forename: M L
authors.initials: ML
authors.lastname: Brown
authors.forename: S G
authors.initials: SG
authors.lastname: Nayfield
authors.forename: L M
authors.initials: LM
authors.lastname: Shibley
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000523:psychology; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007978:Levamisole / Q000008:administration & dosage; D009367:Neoplasm Staging; D011788:Quality of Life
chemical_list: D007978:Levamisole; D005472:Fluorouracil