title: Cost-utility analysis of chemotherapy regimens in elderly patients with stage III colon cancer.
abstract: BACKGROUND
  Chemotherapy prolongs survival for stage III colon cancer patients but community-level evidence on the effectiveness and cost effectiveness of treatment for elderly patients is limited. Comparisons were between patients receiving no chemotherapy, 5-fluorouracil (5-FU), and FOLFOX (5-FU + oxaliplatin).
  
  
  METHODS
  A retrospective cohort study was conducted using the Surveillance Epidemiology, and End Results (SEER)-Medicare linked database. Patients (≥65 years) with American Joint Committee on Cancer stage III colon cancer at diagnosis in 2004-2009 were identified. The 3-way propensity score matched sample included 3,534 patients. Effectiveness was measured in life-years and quality-adjusted life-years (QALYs). Medicare costs (2010 US dollars) were estimated from diagnosis until death or end of study.
  
  
  RESULTS
  FOLFOX patients experienced 6.06 median life-years and 4.73 QALYs. Patients on 5-FU had 5.75 median life-years and 4.50 median QALYs, compared to 3.42 and 2.51, respectively, for the no chemotherapy patients. Average total healthcare costs ranged from US$85,422 for no chemotherapy to US$168,628 for FOLFOX. Incremental cost-effectiveness ratios (ICER) for 5-FU versus no chemotherapy were US$17,131 per life-year gained and US$20,058 per QALY gained. ICERs for FOLFOX versus 5-FU were US$139,646 per life-year gained and US$188,218 per QALY gained. Results appear to be sensitive to age, suggesting that FOLFOX performs better for patients 65-69 and 80+ years old while 5-FU appears most effective and cost effective for the age groups 70-74 and 75-79 years.
  
  
  CONCLUSIONS
  FOLFOX appears more effective and cost effective than other strategies for colon cancer treatment of older patients. Results were sensitive to age, with ICERs exhibiting a U-shaped pattern.
authors.affiliation: Division of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, 1200 Herman Pressler Drive, Houston, TX, 77030, USA, David.R.Lairson@uth.tmc.edu.
authors.forename: David R
authors.initials: DR
authors.lastname: Lairson
authors.forename: Rohan C
authors.initials: RC
authors.lastname: Parikh
authors.forename: Janice N
authors.initials: JN
authors.lastname: Cormier
authors.forename: Wenyaw
authors.initials: W
authors.lastname: Chan
authors.forename: Xianglin L
authors.initials: XL
authors.lastname: Du
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000191:economics; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000191:economics*; D003362:Cost-Benefit Analysis; D017850:Economics, Pharmaceutical; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000191:economics; D006801:Humans; D008297:Male; D009944:Organoplatinum Compounds / Q000008:administration & dosage / Q000191:economics; D000077150:Oxaliplatin; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D005472:Fluorouracil