title: A comparison of mortality and costs associated with FOLFOX versus FOLFIRI in stage IV colorectal cancer.
abstract: OBJECTIVE
  To examine cost and mortality among stage IV colorectal cancer (CRC) patients treated with 5-fluorouracil (5FU)/leucovorin/oxaliplatin (FOLFOX) or 5FU/leucovorin/irinotecan (FOLFIRI).
  
  
  METHODS
  Adult CRC patients newly treated with FOLFOX or FOLFIRI were identified from a large database using medical and pharmacy claims for services delivered January 1, 2002 through December 31, 2005. Cancer stage for a subset of patients was abstracted from medical records. Outcomes were annualized costs calculated for 4 years of observation, and deaths as recorded by the National Death Index. Cost was analyzed using generalized linear modeling; mortality was modeled using Cox proportional hazards analysis.
  
  
  RESULTS
  Unadjusted annualized median and mean costs were $134,401 and $152,213, respectively, for the FOLFOX cohort (n = 41) and $103,150 and $107,994 for the FOLFIRI cohort (n = 86). Death occurred among five (12%) FOLFOX and 42 (53%) FOLFIRI patients. Adjusted analysis revealed no significant difference in cost between cohorts, even after adjusting for reduced irinotecan costs due to generic availability. Incremental costs associated with one additional life saved per year were only $1,236 higher for patients treated with FOLFOX compared with FOLFIRI. Cox analysis revealed a significant survival advantage for FOLFOX over FOLFIRI (HR = 5.2; 95% CI: 1.7-15.8).
  
  
  CONCLUSIONS
  A significant survival benefit was seen for CRC patients receiving FOLFOX versus FOLFIRI; multivariate analysis revealed no significant cost differences. However, the small sample size may have resulted in lack of adequate power to detect a difference between cohorts. There may be factors influencing mortality that were not included in the multivariate modeling.
authors.affiliation: Innovus, Eden Prairie, MN 55344, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Nelson
authors.forename: Sharash
authors.initials: S
authors.lastname: Shetty
authors.forename: Mahesh
authors.initials: M
authors.lastname: Kulakodlu
authors.forename: Carolyn
authors.initials: C
authors.lastname: Harley
authors.forename: Brian
authors.initials: B
authors.lastname: Seal
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000191:economics / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000401:mortality*; D003362:Cost-Benefit Analysis; D005260:Female; D005472:Fluorouracil / Q000191:economics / Q000627:therapeutic use; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D014481:United States
chemical_list: D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil