title: Cost-effectiveness analysis of oxaliplatin compared with 5-fluorouracil/leucovorin in adjuvant treatment of stage III colon cancer in the US.
abstract: BACKGROUND
  The MOSAIC trial demonstrated that oxaliplatin/5-fluorouracil/leucovorin (FU/LV) (FOLFOX4) as adjuvant treatment of TNM stage II and III colon cancer significantly improves disease-free survival compared with 5-FU/LV alone. For stage III patients the 4-year disease-free survival (DFS) was 69% in the FOLFOX4 arm vs 61% in the LV5FU2 arm, P = .002). The cost-effectiveness of FOLFOX4 in stage III patients was evaluated from a US Medicare perspective.
  
  
  METHODS
  By using individual patient-level data from the MOSAIC trial (median follow-up: 44.2 months), DFS and overall survival (OS) were estimated up to 4 years from randomization. DFS was extrapolated from 4 to 5 years by fitting a Weibull model and subsequent survival was estimated from life tables. OS beyond 4 years was predicted from the extrapolated DFS estimates and observed survival after recurrence. Costs were calculated from trial data and external estimates of resources to manage recurrence.
  
  
  RESULTS
  Patients on FOLFOX4 were predicted to gain 2.00 (95% confidence interval [CI]: 0.63, 3.37) years of DFS over those on 5-FU/LV. The predicted life expectancy of stage III patients on FOLFOX4 and 5-FU/LV was 17.61 and 16.26 years, respectively. Mean total lifetime disease-related costs were $56,300 with oxaliplatin and $39,300 with 5-FU/LV. Compared with 5-FU/LV, FOLFOX4 was estimated to cost $20,600 per life-year gained and $22,800 per quality-adjusted life-year (QALY) gained, discounting costs and outcomes at 3% per annum.
  
  
  CONCLUSIONS
  FOLFOX4 is likely to be cost-effective compared with 5-FU/LV in the adjuvant treatment of stage III colon cancer. The incremental cost-effectiveness ratio compares favorably with other funded interventions in oncology.
authors.affiliation: Health Economics and Outcomes, i3 Innovus, Uxbridge, Middlesex, UK. samuel.aballea@i3innovus.com
authors.forename: Samuel
authors.initials: S
authors.lastname: Aballéa
authors.forename: Jeremy V M
authors.initials: JV
authors.lastname: Chancellor
authors.forename: Maria
authors.initials: M
authors.lastname: Raikou
authors.forename: Michael F
authors.initials: MF
authors.lastname: Drummond
authors.forename: Milton C
authors.initials: MC
authors.lastname: Weinstein
authors.forename: Sophia
authors.initials: S
authors.lastname: Jourdan
authors.forename: John
authors.initials: J
authors.lastname: Bridgewater
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant / Q000191:economics; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000601:surgery; D003362:Cost-Benefit Analysis; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000191:economics; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage / Q000191:economics; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage / Q000191:economics*; D000077150:Oxaliplatin; D016019:Survival Analysis; D014481:United States
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D002955:Leucovorin; D005472:Fluorouracil