[CN1] Cost-effectiveness analysis of oxaliplatin/5-fu/lv in adjuvant treatment of stage III colon cancer in the UK and Germany

[CN1] Cost-effectiveness analysis of oxaliplatin/5-fu/lv in adjuvant treatment of stage III colon cancer in the UK and Germany

2005 Value in health

Aballea, S. | Chancellor, J. | Raikou, M. | Drummond, M. | Diel, R. | Frick, M. | Rosenfeld, S. | Boler, A. | Jourdan, S. | Paulo, C. | Bridgewater, J. | Volume: 8, Issue: 6, Pages: A21, analysis, Germany, cost-effectiveness analysis, colon cancer,

OBJECTIVE: In the MOSAIC trial, oxaliplatin/5-fluoruracil/leucovorin
(FOLFOX4) as adjuvant treatment of stage III colon
cancer improved disease-free survival (DFS) at 4 years, compared
to 5-fluorouracil/leucovorin (LV5FU2) (69.7% vs. 61.0%, p =
0.002). We analysed the cost-effectiveness of FOLFOX4 in the
UK and Germany to a lifetime horizon, from a payer perspective.
METHODS: We developed Kaplan-Meier estimates of DFS
and overall survival (OS) to 4 years. DFS was extrapolated from
4 to 5 years with a Weibull model and thereafter from life tables,
adjusting for age and gender, assuming no relapses after 5 years.
Using DFS and observed survival after relapse, we predicted lifetime
OS. Life-years accrued were assigned weights according to
chemotherapy-related toxicities, recurrence and age, to estimate
QALYs. Costs were estimated from trial data, accounting for
censoring; while costs of relapse and subsequent management
were estimated from literature. Costs and QALYs, discounted at
3.5% and 5% per annum for the UK and Germany respectively,
were bootstrapped to estimate the ICER distribution. RESULTS:
Patients on FOLFOX4 gained an estimated mean 0.68 (95% CI:
0.08-1.31) QALYs for the UK and 0.57 (95% CI: 0.04-1.10)
for Germany, at mean incremental costs of £3267 and £5844
respectively, resulting in mean ICERs of £4805 per QALY gained
for the UK and €10,199 for Germany. If the willingness to pay
for additional QALYs were £20,000 in the UK and €50,000 in
Germany, FOLFOX4 would be cost-effective with probabilities
of 95% and 96% in these countries respectively. CONCLUSIONS:
If the estimated survival benefit of oxaliplatin is con-
firmed, FOLFOX4 would cost around £4800 (approx. €6,700)
per QALY gained in the UK and €10,200 in Germany, well
within conventional limits of acceptability. The difference
between countries was largely attributable to the discount rates
used rather than differences in organisation of health care