Postoperative management of stage II/III colon cancer: a decision analysis.
OBJECTIVE
Two separate decisions must be made for the management of patients with resected stage II/III colon cancer: whether to begin adjuvant chemotherapy and whether patients should be included in a follow-up protocol consisting of regular monitoring of carcinoembryonic antigen level and of colonoscopy and imaging. The standard management for these patients is adjuvant chemotherapy for stage III patients and follow-up for stage II/III patients with resected colon cancer.


METHODS
Decision analysis was used to compare the effectiveness (5-year survival rate) and cost-effectiveness ratio of 7 strategies of treatment and follow-up.


RESULTS
The most cost-effective strategies were adjuvant chemotherapy for all patients with stage II/III resected colon cancer, with either no follow-up or follow-up only for patients aged less than 75 years with a seric preoperative carcinoembryonic antigen level of >5 ng/mL (5-year survival, 62.3% or 62.7%; cost per surviving patient, $8254 or $8657, respectively). The order of efficacy of the strategies was insensitive to changes in the values of the studied variables. The method of follow-up does little to improve 5-year survival but adds substantial cost.


CONCLUSIONS
The current standard strategy may not be the most cost-effective strategy for the management of patients with resected colon cancer.
Michel
P
P
Groupe de Recherche sur l'Appareil Digestif, Hôpital Charles Nicolle, Rouen, France. pierre.michel@chu-rouen.fr
Merle
V
V
Chiron
A
A
Ducrotte
P
P
Paillot
B
B
Hecketsweiler
P
P
Czernichow
P
P
Colin
R
R
D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000191:economics / Q000473:pathology* / Q000628:therapy*; D003661:Decision Support Techniques; D017048:Health Care Costs; D006801:Humans; D009367:Neoplasm Staging; D011182:Postoperative Care; D012680:Sensitivity and Specificity; D016019:Survival Analysis