Economic Impact of Alternative Adjuvant Chemotherapy Regimens for Stage III Colon Cancer

Abstract

Background: Adjuvant treatment of stage III colon cancer represents a significant economic burden for the German health care system. The available chemotherapy regimens have significantly different medical and economic profiles. Methods: A modeling study based on published clinical trials was performed to assess costs of 5 different regimens (Mayo Clinic, LV5FU2, FOLFOX-4, Xelox, Capecitabine) from the perspective of the statutory sickness funds. Costs were calculated based on the assumption that patients were treated exactly according to a standardized clinical pathway. Results: Total costs are highest for FOLFOX-4 (H22,034/patient) and Xelox (H21,411). Lowest costs of the oxaliplatin-free treatments are associated with capecitabine (H4,935), followed by the Mayo Clinic (H6,426) and LV5FU2 protocols (H8,336). The main driver of costs in all instances is drug acquisition (90% of total costs), whereas costs of diagnostics or complications have no major impact (0.5–2%). Conclusions: In Germany, FOLFOX-4 is the most effective but also the most expensive treatment and represents the current standard. Xelox emerges as a slightly less costly alternative when oral treatment is preferred. For patients not able to tolerate oxaliplatin-based therapy, capecitabine has the best economic profile of all alternative regimens. Drug acquisition costs are by far the most important factor driving costs in all regimens.

Cost-effectiveness of colorectal cancer screening in Germany: current endoscopic and fecal testing strategies versus plasma methylated Septin 9 DNA

“…Because it can be debated which year’s data are optimal for calibration, we tested the model with the original United States – based calibration and found that compared with the year 2000 German-based calibration, the cost-effectiveness analyses results did not differ with respect to ranking of strategies or dominance between strategies, and that while incremental cost-effectiveness ratios changed some, the differences were not substantial enough to affect interpretation or conclusions. Cost inputs were derived from a literature review 25 26 27 , the doctor’s fee scale and procedure reimbursement (Einheitlicher Bewertungsmaßstab: EBM) catalogue 2011 for office-based physicians with an EBM point value of € 0.035 28 , German Diagnostic Related Group (DRG) codes for hospitalizations 29 , and expert consultations ( Appendix ).…”

Recommendations and expert opinion on the adjuvant treatment of colon cancer in Spain

“…Aballea et al concluded that the incremental cost-effectiveness ratio of FOLFOX4 compared favourably with other funded interventions in oncology in the USA and was likely to be cost effective compared with 5-FU/LV in the adjuvant treatment of stage III CC [45]. For Goerner et al, FOLFOX4 was the most effective adjuvant treatment for stage III CC, representing the current standard in Germany, but was also the most expensive treatment [46]. Conversely, XELOX was found to be a slightly less costly alternative to FOLFOX4 when oral treatment is preferred [46].…”

“…For Goerner et al, FOLFOX4 was the most effective adjuvant treatment for stage III CC, representing the current standard in Germany, but was also the most expensive treatment [46]. Conversely, XELOX was found to be a slightly less costly alternative to FOLFOX4 when oral treatment is preferred [46]. The reduced need for drug administration visits and central venous access with XELOX reduces patient travel and productivity losses, providing patients the freedom to live as normal a life as possible.…”