title: Cost-Effectiveness Analysis of Adjuvant Stage III Colon Cancer Treatment at Veterans Affairs Medical Centers.
abstract: The objective of this study was to evaluate the real-world cost effectiveness of adjuvant stage III colon cancer chemotherapy regimens, given that previous analyses have been based on data from clinical trials. The study was designed using integrated decision tree and Markov model, which was developed to evaluate the cost effectiveness of 5-fluorouracil/leucovorin (5-FU/LV), capecitabine, and the combination of each with oxaliplatin. The analysis was performed from a US Veterans Affairs perspective via retrospectively collected data, over a 5-year model time horizon. Outcome and cost data were used to calculate cost per quality adjusted life year (QALY), and one-way and probabilistic sensitivity analyses were performed. In the base case analysis, capecitabine and capecitabine plus oxaliplatin both cost more and were less effective than other regimens, and 5-FU/LV plus oxaliplatin, compared to 5-FU/LV alone, resulted in a cost of $25,997 per QALY gained. Model results were generally robust to parameter variation. Capecitabine plus oxaliplatin could be economically reasonable if full dosing occurred ≥76% of the time (base case 42%). In a real-world setting, the addition of oxaliplatin to 5-FU/LV is more effective but also more costly than 5-FU/LV alone. If full dosing of capecitabine-containing regimens can be assured, they may also be cost-effective strategies.
authors.affiliation: University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Soni
authors.forename: Sherrie L
authors.initials: SL
authors.lastname: Aspinall
authors.forename: Xinhua
authors.initials: X
authors.lastname: Zhao
authors.forename: Chester B
authors.initials: CB
authors.lastname: Good
authors.forename: Francesca E
authors.initials: FE
authors.lastname: Cunningham
authors.forename: Gurkamal
authors.initials: G
authors.lastname: Chatta
authors.forename: Vida
authors.initials: V
authors.lastname: Passero
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Smith
mesh_terms: D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000191:economics; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000191:economics*; D017024:Chemotherapy, Adjuvant / Q000191:economics; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D003362:Cost-Benefit Analysis / Q000379:methods*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000191:economics; D006787:Hospitals, Veterans / Q000191:economics*; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage / Q000191:economics; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000191:economics; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000191:economics*; D014728:Veterans
chemical_list: D000964:Antimetabolites, Antineoplastic; D002955:Leucovorin; D005472:Fluorouracil