title: Postoperative management of stage II/III colon cancer: a decision analysis.
abstract: 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.
authors.affiliation: Groupe de Recherche sur l'Appareil Digestif, Hôpital Charles Nicolle, Rouen, France. pierre.michel@chu-rouen.fr
authors.forename: P
authors.initials: P
authors.lastname: Michel
authors.forename: V
authors.initials: V
authors.lastname: Merle
authors.forename: A
authors.initials: A
authors.lastname: Chiron
authors.forename: P
authors.initials: P
authors.lastname: Ducrotte
authors.forename: B
authors.initials: B
authors.lastname: Paillot
authors.forename: P
authors.initials: P
authors.lastname: Hecketsweiler
authors.forename: P
authors.initials: P
authors.lastname: Czernichow
authors.forename: R
authors.initials: R
authors.lastname: Colin
mesh_terms: 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