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

Samuel Aballea; Jeremy V. M. Chancellor; Maria Raikou; Michael F. Drummond; Milton C. Weinstein; Sophia Jourdan; John Bridgewater

doi:10.1002/cncr.22512

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

Samuel Aballea, Jeremy V. M. Chancellor, Maria Raikou, Michael F. Drummond, Milton C. Weinstein, Sophia Jourdan, John Bridgewater

Centre for Health Economics

Research output: Contribution to journal › Article › peer-review

Abstract

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-ftee 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 [Cl]: 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; 109:1082-9. (c) 2007 American Cancer Society.

Original language	English
Pages (from-to)	1082-1089
Number of pages	8
Journal	Cancer
Volume	109
Issue number	6
DOIs	https://doi.org/10.1002/cncr.22512
Publication status	Published - 15 Mar 2007

Bibliographical note

Open access copy available from the journal web site.

Keywords

oxaliplatin
colon cancer
cost effectiveness
survival analysis
METASTATIC COLORECTAL-CANCER
QUALITY-OF-LIFE
UTILITY ANALYSIS
FOLLOW-UP
CHEMOTHERAPY
FLUOROURACIL
CARCINOMA
LEUCOVORIN
LEVAMISOLE
THERAPY

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10.1002/cncr.22512

http://dx.doi.org/10.1002/cncr.22512

Cite this

@article{299ac39456154d049f3945a825557b32,

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

abstract = "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-ftee 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 [Cl]: 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; 109:1082-9. (c) 2007 American Cancer Society.",

keywords = "oxaliplatin, colon cancer, cost effectiveness, survival analysis, METASTATIC COLORECTAL-CANCER, QUALITY-OF-LIFE, UTILITY ANALYSIS, FOLLOW-UP, CHEMOTHERAPY, FLUOROURACIL, CARCINOMA, LEUCOVORIN, LEVAMISOLE, THERAPY",

author = "Samuel Aballea and Chancellor, {Jeremy V. M.} and Maria Raikou and Drummond, {Michael F.} and Weinstein, {Milton C.} and Sophia Jourdan and John Bridgewater",

note = "Open access copy available from the journal web site.",

year = "2007",

month = mar,

day = "15",

doi = "10.1002/cncr.22512",

language = "English",

volume = "109",

pages = "1082--1089",

journal = "Cancer",

issn = "0008-543X",

publisher = "Wiley-Blackwell",

number = "6",

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TY - JOUR

T1 - Cost-effectiveness analysis of oxaliplatin compared with 5-fluorouracil/leucovorin in adjuvant treatment of stage III colon cancer in the US

AU - Aballea, Samuel

AU - Chancellor, Jeremy V. M.

AU - Raikou, Maria

AU - Drummond, Michael F.

AU - Weinstein, Milton C.

AU - Jourdan, Sophia

AU - Bridgewater, John

N1 - Open access copy available from the journal web site.

PY - 2007/3/15

Y1 - 2007/3/15

N2 - 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-ftee 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 [Cl]: 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; 109:1082-9. (c) 2007 American Cancer Society.

AB - 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-ftee 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 [Cl]: 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; 109:1082-9. (c) 2007 American Cancer Society.

KW - oxaliplatin

KW - colon cancer

KW - cost effectiveness

KW - survival analysis

KW - METASTATIC COLORECTAL-CANCER

KW - QUALITY-OF-LIFE

KW - UTILITY ANALYSIS

KW - FOLLOW-UP

KW - CHEMOTHERAPY

KW - FLUOROURACIL

KW - CARCINOMA

KW - LEUCOVORIN

KW - LEVAMISOLE

KW - THERAPY

U2 - 10.1002/cncr.22512

DO - 10.1002/cncr.22512

M3 - Article

SN - 0008-543X

VL - 109

SP - 1082

EP - 1089

JO - Cancer

JF - Cancer

IS - 6

ER -