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Abstract
Background: In Thailand, there has been no economic evaluation study of adjuvant chemotherapy for stage III colon cancer patients after resection. Objective: This study aims to evaluate the cost-utility of all chemotherapy regimens currently used in Thailand compared with the adjuvant 5-fluorouracil/leucovorin (5-FU/LV) plus capecitabine as the first-line therapy for metastatic disease in patients with stage III colon cancer after resection. Methods: A cost-utility analysis was performed to estimate the relevant lifetime costs and health outcomes of chemotherapy regimens based on a societal perspective using a Markov model. Results: The results suggested that the adjuvant 5-FU/LV plus capecitabine as the first-line therapy for metastatic disease would be the most cost–effective chemotherapy. Conclusions: The adjuvant FOLFOX and FOLFIRI as the first-line treatment for metastatic disease would be cost–effective with an incremental cost–effectiveness ratio of 299,365 Thai baht per QALY gained based on a societal perspective if both prices of FOLFOX and FOLFIRI were decreased by 40%.
Acknowledgements
The authors would like to thank the Faculty of Pharmacy, Mahidol University and the National Cancer Institute for research facilities and data collection as well as all staff and study participants at the National Cancer Institute, Thailand who contributed to this study.
Financial & competing interests disclosure
Funding support was given through the Health Intervention and Technology Assessment Program (HITAP) from the Thai Health Promotion Foundation, the National Health System Research Institute (HSRI) and the Bureau of Health Policy and Strategy, Ministry of Public Health. In addition, HITAP is supported by the Thailand Research Fund under the Senior Research Scholar on Health Technology Assessment (RTA5580010) and the Thai Health Global Link Initiative Program (TGLIP), supported by the Thai Health Promotion Foundation. 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.
No writing assistance was utilized in the production of this manuscript.
Adjuvant chemotherapy regimens can significantly prolong patients’ survival; however, oxaliplatin added regimens are very costly. In Thailand, there has been no economic evaluation study of adjuvant chemotherapy for stage III colon cancer patients after resection.
The total cost of the adjuvant 5-FU/LV and the first-line capecitabine for metastatic disease was the lowest at 586,000 THB, while that of the adjuvant XELOX and the first-line FOLFIRI for metastatic disease was the highest at 1,762,000 THB. All interventions had higher cost and yielded more LYs than the adjuvant 5-FU/LV plus the first-line capecitabine for metastatic disease.
The adjuvant 5-FU/LV plus the first-line capecitabine for metastatic disease would be the most cost-effective chemotherapy.
The adjuvant FOLFOX and the first-line FOLFIRI for metastatic disease, the next best intervention, would be cost-effective with an ICER of 299,365 THB per QALY gained based on a societal perspective if both prices of FOLFOX and FOLFIRI were decreased by 40%.