Cost-effectiveness of second-line treatment with irinotecan or infusional 5-fluorouracil in metastatic colorectal cancer.
BACKGROUND
It has been shown that irinotecan is superior to infusional 5-fluorouracil (5-FU) in patients with advanced colorectal cancer after 5-FU failure. In a recent trial, median survival was 10.8 months for patients treated with irinotecan, compared to 8.5 months in patients receiving infusional 5-FU. Considering the statistically significant but clinically relatively small advantage of irinotecan over 5-FU, cost effectiveness should also be part of treatment decision.


OBJECTIVE
To relate the costs of each management approach to overall survival in patients with metastatic colorectal cancer.


METHODS
The healthcare costs and medical benefits (treatment-added survival) of second-line chemotherapy in patients (infusional 5-FU: 129, irinotecan: 127) were compared. Data on overall survival were drawn from a multicenter randomised trial that compared infusional 5-FU (continuous infusion, AIO, or LV5-FU2 regimens) to irinotecan alone. Costs were derived from the accounting system in two university hospitals in Paris, France.


RESULTS
The range in total healthcare costs was 14,135 to 12,192 US$ patient between management approaches, with irinotecan chemotherapy costing most and 5-FU-continuous infusion least. If survival was included as a treatment benefit, the cost-effectiveness ratio of irinotecan over 5-FU ranged from 9,344 to 10,137 US$ per year of added survival.


CONCLUSIONS
The least expensive management for metastatic colorectal was 5-FU infusion but the additional cost of irinotecan was balanced by the added months of survival, with a cost-effectiveness ratio close to that of other cancer treatments.
Levy-Piedbois
C
C
Institut Gustave Roussy, Department of Public Health and Informatics, Villejuif, France.
Durand-Zaleski
I
I
Juhel
H
H
Schmitt
C
C
Bellanger
A
A
Piedbois
P
P
D000230:Adenocarcinoma / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000401:mortality / Q000556:secondary*; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D004334:Drug Administration Schedule; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000191:economics*; D005602:France; D017048:Health Care Costs; D017721:Hospital Costs; D006801:Humans; D007262:Infusions, Intravenous; D000077146:Irinotecan; D008297:Male; D008875:Middle Aged; D016879:Salvage Therapy; D012680:Sensitivity and Specificity; D016019:Survival Analysis
D000077146:Irinotecan; D005472:Fluorouracil; D002166:Camptothecin