Cost-effectiveness of adjuvant chemotherapy with uracil–tegafur for curatively resected stage III rectal cancer

Abstract

Recently, the National Surgical Adjuvant Study of Colorectal Cancer in Japan, a randomised controlled trial of oral uracil -tegafur (UFT) adjuvant therapy for stage III rectal cancer, showed remarkable survival gains, compared with surgery alone. To evaluate value for money of adjuvant UFT therapy, cost-effective analysis was carried out. Cost-effectiveness analysis of adjuvant UFT therapy was carried out from a payer's perspective, compared with surgery alone. Overall survival and relapse-free survival were estimated by Kaplan -Meier method, up to 5.6 years from randomisation. Costs were estimated from trial data during observation. Qualityadjusted life-years (QALYs) were calculated using utility score from literature. Beyond observation period, they were simulated by the Boag model combined with the competing risk model. For 5.6-year observation, 10-year follow-up and over lifetime, adjuvant UFT therapy gained 0.50, 0.96 and 2.28 QALYs, and reduced costs by $2457, $1771 and $1843 per person compared with surgery alone, respectively (3% discount rate for both effect and costs). Cost-effectiveness acceptability and net monetary benefit analyses showed the robustness of these results. Economic evaluation of adjuvant UFT therapy showed that this therapy is cost saving and can be considered as a cost-effective treatment universally accepted for wide use in Japan.

Cost-minimization analysis of adjuvant chemotherapy regimens given to patients with colorectal cancer in Japan

“…We compared the costs required for the following 3 categories between the present study and previous studies based on large international phase 3 trials: 1) anticancer drugs, 2) drugs used for supportive care, and 3) laboratory tests. 1) The previously estimated cost of 1 year of treatment with UFT (about 393,700 yen [3937 dollars]) [15] was generally similar to the cost calculated by us (i.e., about 360,200 yen [3602 dollars], equivalent to twice the cost of 6 months’ treatment with UFT in our study). However, the cost of capecitabine calculated in a previous study (540,000 yen [5400 dollars]) [16] was higher than that estimated by us (about 420,500 yen [4205 dollars]).…”

“…The total costs were calculated with the use of clinical and cost data obtained from Japanese patients who received each regimen of adjuvant chemotherapy in clinical practice. This is in contrast to most previous studies assessing the costs of adjuvant chemotherapy for colorectal cancer in Japan, which based the costs of treatment on clinical data obtained from large phase 3 clinical trials [15–17]. …”

“…To date, three studies of cost-effectiveness employing clinical data from phase 3 clinical trials have been performed: Hisashige et al [15] analyzed the cost-effectiveness of UFT by comparing clinical and cost data between patients who received or did not receive UFT in the NSAS CC trial [22]. In other Japanese studies, the cost-effectiveness of 5-FU/LV and capecitabine [16] was evaluated with the use of clinical data from X-ACT trial [13], and that of 5-FU/LV and FOLFOX4 [17] was evaluated with the use of data from the MOSAIC trial [9].…”

“…Several economic studies have examined the cost-effectiveness of adjuvant chemotherapy for colorectal cancer in Japan [15–17]. The clinical data used in these studies were derived from international phase 3 trials, but not based on clinical practice.…”

Neo adjuvant chemo-radiotherapy and rectal cancer: Can India follow the West?

“…Thus, economic evaluations in area of rectal cancer of these fast-changing chemotherapy combinations should be conducted on a routine basis along with determination of clinical benefits and efficacy. [26] CONCLUSION This study represents the first Indian experience with preoperative chemo radiotherapy for loco regionally advanced rectal cancer with higher percentage of them requiring diversion colostomy prior to starting any treatment and have poor outcome as compared to western literature. In our set of patients, the compliance to complete treatment has to be evaluated since the fear of permanent colostomy as well as symptomatic response lead to failure of protocol and thus affect outcome.…”