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Cost-Effectiveness of Adjuvant FOLFOX and 5FU/LV Chemotherapy for Patients with Stage II Colon Cancer

Author

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  • Mehmet U. S. Ayvaci
  • Jinghua Shi
  • Oguzhan Alagoz
  • Sam J. Lubner

Abstract

Purpose . 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. Methods . 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. Results . 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. Conclusion . 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.

Suggested Citation

  • Mehmet U. S. Ayvaci & Jinghua Shi & Oguzhan Alagoz & Sam J. Lubner, 2013. "Cost-Effectiveness of Adjuvant FOLFOX and 5FU/LV Chemotherapy for Patients with Stage II Colon Cancer," Medical Decision Making, , vol. 33(4), pages 521-532, May.
    • Handle: RePEc:sae:medema:v:33:y:2013:i:4:p:521-532
    DOI: 10.1177/0272989X12470755
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    Cited by:

    1. Ali Hajjar & Mehmet A Ergun & Oguzhan Alagoz & Murtuza Rampurwala, 2019. "Cost-effectiveness of adjuvant paclitaxel and trastuzumab for early-stage node-negative, HER2-positive breast cancer," PLOS ONE, Public Library of Science, vol. 14(6), pages 1-14, June.
    2. Gabrielle Jongeneel & Marjolein J. E. Greuter & Felice N. Erning & Miriam Koopman & Jan P. Medema & Raju Kandimalla & Ajay Goel & Luis Bujanda & Gerrit A. Meijer & Remond J. A. Fijneman & Martijn G. H, 2020. "Modeling Personalized Adjuvant TreaTment in EaRly stage coloN cancer (PATTERN)," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(7), pages 1059-1073, September.

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