Quality of life and cost of strategies of two chemotherapy lines in metastatic colorectal cancer: results of the FFCD 2000-05 trial

ABSTRACT

Objectives: This study compared the cost and quality of life (QoL) of 407 advanced colorectal cancer patients, randomly assigned to receive LV5FU2 followed by FOLFOX6 (sequential strategy) or FOLFOX6 followed by FOLFIRI (combination strategy).

Methods: Costs were compared from the French health insurance perspective, until the end of the second line of treatment. Consumed resources, collected during the trial, included medicines, hospitalizations, examinations, and transportation. Valuations were made using 2009 and 2016 tariffs. QoL was assessed using the QLQ-C30 questionnaire and clinically significant variations were searched.

Results: In 2009, the mean cost per patient was significantly lower for the sequential strategy compared to the combination strategy (18,061€ and 23,119€, p = 0.001). In 2016, the difference was no longer significant (16,876€ and 18,090€, p = 0.41) because oxaliplatin and irinotecan became generics. The QoL analysis (292 patients) showed that there was significantly less improvement of global health status in the sequential strategy than in the combination strategy (29% and 42%; p = 0.02) during first-line therapy. No significant differences were observed for emotional functioning (p = 0.45) and physical functioning (p = 0.07) or during second-line therapy.

Conclusion: The choice to treat patients with advanced colorectal cancer using one or the other strategy cannot be based on costs or QoL.

KEYWORDS:

• Metastatic colorectal cancer
• quality of life
• cost
• randomised trial
• oxaliplatin
• irinotecan

Author Contributions

O. Bouché, M. Ducreux, and J-P Pignon had full control of the study design. Analyses were performed by B. Lacas and I. Borget. B. Lacas, I. Borget, and J-P Pignon drafted the manuscript. All authors interpreted the data, reviewed the manuscript and agree to be accountable for all aspects of the work.

Declaration of interest

O Bouché and M Ducreux participated in other trials funded or part-funded by the manufacturers of irinotecan (Aventis at the beginning of the trial, then Pfizer), oxaliplatin (Sanofi and then Sanofi-Aventis), or both, and received educational support in the form of travel bursaries or departmental research support from the manufacturers of these two medicines, C. Lombard-Bohas reports consulting fees from Sanofi. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

The FFCD 2000-05 is registered on clinicaltrials.gov (NCT00126256) and was supported by an unrestricted grant from Sanofi France. The FFCD thanks the Ligue Nationale Contre le Cancer, who provided financial support to FFCD.