Innovative chemotherapies for stage III colon cancer: a cost-effectiveness study.
OBJECTIVE
The lower mortality rate associated with Oxaliplatin or Irinotecan added to Fluorouracil chemotherapy for stage III colon cancer should outweigh significantly higher costs of these therapies. While efficacy data currently are lacking, our aim was to generate cost-effectiveness data about a range of potential benefits to define the increase in mortality reduction required for the future acceptance of these new chemotherapies.


METHODS
Estimates of efficacy were derived from the literature. Forty-seven of our patients treated with Oxaliplatin or Fluorouracil/Leucovorin alone were evaluated for cost-analysis.


RESULTS
Three scenarios for Oxaliplatin chemotherapies were constructed with a 20% to 50% increase of mortality reduction at 5 years after surgery when compared to Fluorouracil chemotherapy. The associated increase of cost-effectiveness ratio to Fluorouacil chemotherapy was 92% to 36%. A sensitivity analysis for various key input parameters demonstrated the robustness of the model overall. Only the choice of another chemotherapy schedule may significantly alter cost-effective ratios (p < 0.001).


CONCLUSIONS
Even the most conservative scenario showed a discounted cost-effectiveness ratio of only 12,485 per life year gained, when compared to best supportive care and therefore met strict cost-effectiveness standards. Oxaliplatin chemotherapy should be accepted for all patients with stage III colon cancer if the required 20% increase in mortality reduction is achieved. Because of the high impact on cost-effectiveness each more expensive chemo-therapy schedule with higher overall dosage should first prove its superior clinical efficacy.
Koperna
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Department of Surgery, Hospital Mistelbach, Liechtensteinstrasse 67, A-2130 Mistelbach, Austria. t.koperna@aon.at
Semmler
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D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality / Q000473:pathology; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D018572:Disease-Free Survival; D016527:Drug Costs / Q000706:statistics & numerical data*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics; D002955:Leucovorin / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D008113:Liver Neoplasms / Q000188:drug therapy / Q000191:economics / Q000401:mortality / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D000077150:Oxaliplatin; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate
D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D002955:Leucovorin; D005472:Fluorouracil