Retrospective Study
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World J Gastroenterol. Dec 21, 2014; 20(47): 17976-17984
Published online Dec 21, 2014. doi: 10.3748/wjg.v20.i47.17976
Cost-effectiveness analysis of colon cancer treatments from MOSIAC and No. 16968 trials
Feng Wen, Ke Yao, Ze-Dong Du, Xiao-Feng He, Peng-Fei Zhang, Rui-Lei Tang, Qiu Li
Feng Wen, Peng-Fei Zhang, Rui-Lei Tang, Qiu Li, Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Ke Yao, Department of Biostatistics, West China School of Public Health, Sichuan University, Chengdu 610041, Sichuan Province, China
Ze-Dong Du, Department of Oncology, 363 Hospital, Chengdu 610041, Sichuan Province, China
Xiao-Feng He, Department of Medical Oncology, First People’s Hospital of Longquanyi District, Chengdu 610041, Sichuan Province, China
Author contributions: Li Q and Wen F performed the majority of the research, including study design, data collection, data analysis and interpretation; they also wrote the manuscript; Yao K and Zhang PF provided analytical tools and edited the manuscript; Du ZD and He XF collected the related material; Tang RL helped to complete the tables and figures; all the authors gave their final approval to the manuscript.
Supported by National Natural Science Foundation of China, No. 81071862
Correspondence to: Qiu Li, MD, PhD, Professor, Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Guoxuexiang 37, Wuhou District, Chengdu 610041, Sichuan Province, China. fbqiu9@163.com
Telephone: +86-28-85423262 Fax: +86-28-85423609
Received: April 21, 2014
Revised: July 5, 2014
Accepted: August 13, 2014
Published online: December 21, 2014
Abstract

AIM: To compare XELOX and FOLFOX4 as colon cancer adjuvant chemotherapy based on MOSAIC and No. 16968 trails from Chinese cost-effectiveness perspective.

METHODS: A decision-analytic Markov model was developed to compare the FOLFOX4 and XELOX regimens based MOSAIC and No. 16968 trial. Five states were included in our Markov model: well (state 1), minor toxicity (state 2), major toxicity (state 3), quitting adjuvant chemotherapy (state 4), and death due to adjuvant chemotherapy (state 5). Transitions among the 5 states were assumed to be Markovian. Costs were calculated from the perspective of the Chinese health-care payer. The utility data were taken from published studies. Sensitivity analyses were used to explore the impact of uncertainty factors in this cost-effectiveness analysis.

RESULTS: Total direct costs of FOLFOX4 and XELOX per patient were $19884.96 ± 4280.30 and $18113.25 ± 3122.20, respectively. The total fees related to adverse events per patient during the entire treatment were $204.75 ± 16.80 for the XELOX group, and $873.72 ± 27.60 for the FOLFOX4 group, and the costs for travel and absenteeism per patient were $18495.00 for the XELOX group and $21,352.68 for the FOLFOX4 group. The base-case analysis showed that FOLFOX4 was estimated to produce an additional 0.06 in quality adjusted life years (QALYs) at an additional cost of $3950.47 when compared to the XELOX regimen over the model time horizon. The cost per QALY gained was $8047.30 in the XELOX group, which was $900.98 less than in the FOLFOX4 group ($8948.28). The one way sensitivity analysis demonstrated that the utility for the well state and minor toxicity state greatly influenced the incremental cost-effectiveness ratio of FOLFOX4.

CONCLUSION: In term of cost-comparison, XELOX is expected to dominate FOLFOX4 regimes; Therefore, XELOX provides a more cost-effective adjuvant chemotherapy for colon cancer patients in China.

Keywords: Cost-effectiveness, Adjuvant chemotherapy, Colon cancer, FOLFOX, XELOX

Core tip: Notably, patients with stage III colon cancer are recommended to receive either XELOX or FOLFOX4 as adjuvant therapy. However, there has not been a cost-effectiveness analysis of these two regimens. This study compared XELOX and FOLFOX4 as adjuvant chemotherapy for patients with colon cancer based on the MOSAIC and No. 16968 trails from a Chinese cost-effectiveness perspective. Our results demonstrated that XELOX was a more cost-effective treatment for adjuvant chemotherapy of colon cancer in China.