title: Cost-effectiveness analysis of colon cancer treatments from MOSIAC and No. 16968 trials.
abstract: OBJECTIVE
  To compare XELOX and FOLFOX4 as colon cancer adjuvant chemotherapy based on MOSAIC and No. 16968 trails from Chinese cost-effectiveness perspective.
  
  
  METHODS
  A decision-analytic Markov model was developed to compare the FOLFOX4 and XELOX regimens based MOSAIC and No. 16968 trial. Five states were included in our Markov model: well (state 1), minor toxicity (state 2), major toxicity (state 3), quitting adjuvant chemotherapy (state 4), and death due to adjuvant chemotherapy (state 5). Transitions among the 5 states were assumed to be Markovian. Costs were calculated from the perspective of the Chinese health-care payer. The utility data were taken from published studies. Sensitivity analyses were used to explore the impact of uncertainty factors in this cost-effectiveness analysis.
  
  
  RESULTS
  Total direct costs of FOLFOX4 and XELOX per patient were $19884.96 ± 4280.30 and $18113.25 ± 3122.20, respectively. The total fees related to adverse events per patient during the entire treatment were $204.75 ± 16.80 for the XELOX group, and $873.72 ± 27.60 for the FOLFOX4 group, and the costs for travel and absenteeism per patient were $18495.00 for the XELOX group and $21,352.68 for the FOLFOX4 group. The base-case analysis showed that FOLFOX4 was estimated to produce an additional 0.06 in quality adjusted life years (QALYs) at an additional cost of $3950.47 when compared to the XELOX regimen over the model time horizon. The cost per QALY gained was $8047.30 in the XELOX group, which was $900.98 less than in the FOLFOX4 group ($8948.28). The one way sensitivity analysis demonstrated that the utility for the well state and minor toxicity state greatly influenced the incremental cost-effectiveness ratio of FOLFOX4.
  
  
  CONCLUSIONS
  In term of cost-comparison, XELOX is expected to dominate FOLFOX4 regimes; Therefore, XELOX provides a more cost-effective adjuvant chemotherapy for colon cancer patients in China.
authors.affiliation: Feng Wen, Peng-Fei Zhang, Rui-Lei Tang, Qiu Li, Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Wen
authors.affiliation: Feng Wen, Peng-Fei Zhang, Rui-Lei Tang, Qiu Li, Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Ke
authors.initials: K
authors.lastname: Yao
authors.affiliation: Feng Wen, Peng-Fei Zhang, Rui-Lei Tang, Qiu Li, Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Ze-Dong
authors.initials: ZD
authors.lastname: Du
authors.affiliation: Feng Wen, Peng-Fei Zhang, Rui-Lei Tang, Qiu Li, Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Xiao-Feng
authors.initials: XF
authors.lastname: He
authors.affiliation: Feng Wen, Peng-Fei Zhang, Rui-Lei Tang, Qiu Li, Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Peng-Fei
authors.initials: PF
authors.lastname: Zhang
authors.affiliation: Feng Wen, Peng-Fei Zhang, Rui-Lei Tang, Qiu Li, Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Rui-Lei
authors.initials: RL
authors.lastname: Tang
authors.affiliation: Feng Wen, Peng-Fei Zhang, Rui-Lei Tang, Qiu Li, Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Qiu
authors.initials: Q
authors.lastname: Li
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D000069287:Capecitabine; D017024:Chemotherapy, Adjuvant / Q000191:economics; D002681:China; D002986:Clinical Trials as Topic; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality / Q000473:pathology; D003362:Cost-Benefit Analysis; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics; D016527:Drug Costs; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage / Q000191:economics; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D009944:Organoplatinum Compounds / Q000008:administration & dosage / Q000191:economics; D000077150:Oxaliplatin; D010071:Oxaloacetates; D019057:Quality-Adjusted Life Years; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D009944:Organoplatinum Compounds; D010071:Oxaloacetates; D000077150:Oxaliplatin; D003841:Deoxycytidine; D000069287:Capecitabine; D002955:Leucovorin; D005472:Fluorouracil
keywords: Adjuvant chemotherapy; Colon cancer; Cost-effectiveness; FOLFOX; XELOX