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Cost-effectiveness analysis of oxaliplatin compared with 5-fluorouracil/leucovorin in adjuvant treatment of stage III colon cancer in the US

Aballea, S., Chancellor, J.V.M., Raikou, M., Drummond, M.F., Weinstein, M.C., Jourdan, S. and Bridgewater, J. (2007) Cost-effectiveness analysis of oxaliplatin compared with 5-fluorouracil/leucovorin in adjuvant treatment of stage III colon cancer in the US. Cancer, 109 (6). pp. 1082-1089. ISSN 0008-543X

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BACKGROUND : The MOSAIC trial demonstrated that oxaliplatin/5-fluorouracil/leucovorin (FU/LV) (FOLFOX4) as adjuvant treatment of TNM stage II and III colon cancer significantly improves disease-free survival compared with 5-FU/LV alone. For stage III patients the 4-year disease-free survival (DFS) was 69% in the FOLFOX4 arm vs 61% in the LV5FU2 arm, P = .002). The cost-effectiveness of FOLFOX4 in stage III patients was evaluated from a US Medicare perspective.

METHODS : By using individual patient-level data from the MOSAIC trial (median follow-up: 44.2 months), DFS and overall survival (OS) were estimated up to 4 years from randomization. DFS was extrapolated from 4 to 5 years by fitting a Weibull model and subsequent survival was estimated from life tables. OS beyond 4 years was predicted from the extrapolated DFS estimates and observed survival after recurrence. Costs were calculated from trial data and external estimates of resources to manage recurrence.

RESULTS : Patients on FOLFOX4 were predicted to gain 2.00 (95% confidence interval [CI]: 0.63, 3.37) years of DFS over those on 5-FU/LV. The predicted life expectancy of stage III patients on FOLFOX4 and 5-FU/LV was 17.61 and 16.26 years, respectively. Mean total lifetime disease-related costs were $56,300 with oxaliplatin and $39,300 with 5-FU/LV. Compared with 5-FU/LV, FOLFOX4 was estimated to cost $20,600 per life-year gained and $22,800 per quality-adjusted life-year (QALY) gained, discounting costs and outcomes at 3% per annum.

CONCLUSIONS : FOLFOX4 is likely to be cost-effective compared with 5-FU/LV in the adjuvant treatment of stage III colon cancer. The incremental cost-effectiveness ratio compares favorably with other funded interventions in oncology. Cancer 2007 © 2007 American Cancer Society.

Item Type: Article
Copyright, Publisher and Additional Information: Open access copy available from the journal web site.
Keywords: oxaliplatin, colon cancer, cost effectiveness, survival analysis
Institution: The University of York
Academic Units: The University of York > Centre for Health Economics (York)
Depositing User: Open Access From Journal
Date Deposited: 23 Dec 2008 13:42
Last Modified: 23 Dec 2008 13:42
Published Version: http://dx.doi.org/10.1002/cncr.22512
Status: Published
Publisher: Wiley-Blackwell
Refereed: Yes
Identification Number: 10.1002/cncr.22512
URI: http://eprints.whiterose.ac.uk/id/eprint/5054

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