title: Cost-effectiveness of adjuvant FOLFOX and 5FU/LV chemotherapy for patients with stage II colon cancer.
abstract: We evaluated the cost-effectiveness of adjuvant chemotherapy using 5-fluorouracil, leucovorin (5FU/LV), and oxaliplatin (FOLFOX) compared with 5FU/LV alone and 5FU/LV compared with observation alone for patients who had resected stage II colon cancer.
  
  
  
  We developed 2 Markov models to represent the adjuvant chemotherapy and follow-up periods and a single Markov model to represent the observation group. We used calibration to estimate the transition probabilities among different toxicity levels. The base case considered 60-year-old patients who had undergone an uncomplicated hemicolectomy for stage II colon cancer and were medically fit to receive 6 months of adjuvant chemotherapy. We measured health outcomes in quality-adjusted life-years (QALYs) and estimated costs using 2007 US dollars.
  
  
  
  In the base case, adjuvant chemotherapy of the FOLFOX regimen had an incremental cost-effectiveness ratio (ICER) of $54,359/QALY compared with the 5FU/LV regimen, and the 5FU/LV regimen had an ICER of $14,584/QALY compared with the observation group from the third-party payer perspective. The ICER values were most sensitive to 5-year relapse probability, cost of adjuvant chemotherapy, and the discount rate for the FOLFOX arm, whereas the ICER value of 5FU/LV was most sensitive to the 5-year relapse probability, 5-year survival probability, and the relapse cost. The probabilistic sensitivity analysis indicates that the ICER of 5FU/LV is less than $50,000/QALY with a probability of 99.62%, and the ICER of FOLFOX as compared with 5FU/LV is less than $50,000/QALY and $100,000/QALY with a probability of 44.48% and 97.24%, respectively.
  
  
  
  Although adjuvant chemotherapy with 5FU/LV is cost-effective at all ages for patients who have undergone an uncomplicated hemicolectomy for stage II colon cancer, FOLFOX is not likely to be cost-effective as compared with 5FU/LV.
authors: Information Systems and Operations Management, University of Texas at Dallas, Richardson, Texas (MA)
authors: Mehmet U S
authors: MU
authors: Ayvaci
authors: China Minsheng Banking Corporation, Beijing, P.R. China (JS)
authors: Jinghua
authors: J
authors: Shi
authors: Department of Industrial and Systems Engineering, University of Wisconsin–Madison, Madison, Wisconsin and Department of Industrial Engineering, Bilkent University, Ankara, Turkey (OA)
authors: Oguzhan
authors: O
authors: Alagoz
authors: Carbone Comprehensive Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin (SL)
authors: Sam J
authors: SJ
authors: Lubner
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000601:surgery; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D005472:Fluorouracil / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D008390:Markov Chains; D009944:Organoplatinum Compounds / Q000009:adverse effects / Q000627:therapeutic use; D011336:Probability; D019057:Quality-Adjusted Life Years; D015996:Survival Rate
chemical_list: D009944:Organoplatinum Compounds; D002955:Leucovorin; D005472:Fluorouracil
keywords: Markov model; calibration; colon cancer; cost-effectiveness; stage II