The value of new chemotherapeutic agents for metastatic colorectal cancer.
BACKGROUND
New chemotherapeutic agents for patients diagnosed with metastatic colorectal cancer have been singled out as examples of high-cost/low-value medical care. We measure trends in life expectancy and lifetime medical costs in this patient population between January 1, 1995, and December 31, 2005.


METHODS
Using the Surveillance, Epidemiology, and End Results-Medicare database, we constructed a sample of 4665 patients aged 66 and older diagnosed with metastatic colorectal cancer between January 1, 1995, and December 31, 2005, who received chemotherapeutic agents. We estimated life expectancy and lifetime medical costs based on observed short-term survival rates and costs.


RESULTS
Life expectancy increased by 6.8 months and lifetime costs by $37 100 (2006 dollars). The implied cost per life-year gained is $66 200 (95% confidence interval, $48 100-$84 200). After discounting life-years and costs and adjusting for patients' health utility and out-of-pocket payments, the cost per quality-adjusted life-year gained is $99 100 (95% confidence interval, $72 300-$125 900).


CONCLUSIONS
New chemotherapeutic agents are associated with improvements in survival time but also with substantial costs. The cost-effectiveness ratio for these drugs as a group is below commonly cited estimates of the willingness-to-pay for a life-year. However, open-ended coverage policies for new chemotherapeutic agents may prove difficult to sustain as costs continue to rise.
Department of Health Policy and Management, Emory University, Atlanta, GA 30030, USA. david.howard@emory.edu
David H
DH
Howard
John
J
Kauh
Joseph
J
Lipscomb
D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use*; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000473:pathology*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008297:Male; D009362:Neoplasm Metastasis / Q000188:drug therapy*; D009367:Neoplasm Staging; D016896:Treatment Outcome
D000970:Antineoplastic Agents