Cost–Utility Analysis of Chemotherapy Regimens in Elderly Patients with Stage III Colon Cancer
Chemotherapy prolongs survival for stage III colon cancer patients but community-level evidence on the effectiveness and cost effectiveness of treatment for elderly patients is limited. Comparisons were between patients receiving no chemotherapy, 5-fluorouracil (5-FU), and FOLFOX (5-FU + oxaliplatin).
A retrospective cohort study was conducted using the Surveillance Epidemiology, and End Results (SEER)–Medicare linked database. Patients (≥65 years) with American Joint Committee on Cancer stage III colon cancer at diagnosis in 2004–2009 were identified. The 3-way propensity score matched sample included 3,534 patients. Effectiveness was measured in life-years and quality-adjusted life-years (QALYs). Medicare costs (2010 US dollars) were estimated from diagnosis until death or end of study.
FOLFOX patients experienced 6.06 median life-years and 4.73 QALYs. Patients on 5-FU had 5.75 median life-years and 4.50 median QALYs, compared to 3.42 and 2.51, respectively, for the no chemotherapy patients. Average total healthcare costs ranged from US$85,422 for no chemotherapy to US$168,628 for FOLFOX. Incremental cost-effectiveness ratios (ICER) for 5-FU versus no chemotherapy were US$17,131 per life-year gained and US$20,058 per QALY gained. ICERs for FOLFOX versus 5-FU were US$139,646 per life-year gained and US$188,218 per QALY gained. Results appear to be sensitive to age, suggesting that FOLFOX performs better for patients 65–69 and 80+ years old while 5-FU appears most effective and cost effective for the age groups 70–74 and 75–79 years.
FOLFOX appears more effective and cost effective than other strategies for colon cancer treatment of older patients. Results were sensitive to age, with ICERs exhibiting a U-shaped pattern.
KeywordsPropensity Score Oxaliplatin Veteran Administration Health Propensity Score Match Electronic Supplementary Material Figure
This study was supported by a grant from the Agency for Healthcare Research and Quality (R01-HS018956) and in part by a grant from Cancer Prevention Research Institute of Texas (RP130051). The authors have no conflicts of interest to declare. Authors D.L., R.P., and X.D. were primarily responsible for study design, data analysis, and manuscript writing. Authors J.C. and W.C. were responsible for study design, interpretation of data, and critical review of the manuscript. D.L. is the overall guarantor for the content.
- 3.Polychemotherapy for early breast cancer: an overview of the randomised trials. Early Breast Cancer Trialists’ Collaborative Group. Lancet. 1998;352(9132):930–42.Google Scholar
- 11.Food and Drug Administration. Eloxatin: new or modified indication. Washington, DC: US Food and Drug Administration; 2004.Google Scholar
- 14.Pandor A, Eggington S, Paisley S, Tappenden P, Sutcliffe PA. The clinical and cost-effectiveness of oxaliplatin and capecitabine for the adjuvant treatment of colon cancer: systematic review and economic evaluation. Health Technol Assess. 2006;10(41):1–204.Google Scholar
- 18.Warren JL, Klabunde CN, Schrag D, Bach PB, Riley GF. Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population. Med Care. 2002;40(8):IV-3–-18.Google Scholar
- 19.Rassen JA, Doherty M, Huang W, Schneeweiss S. Pharmacoepidemiology toolbox; 2013. http://www.drugepi.org/wp-content/uploads/2013/10/Using_the_Pharmacoepi_Toolbox_in_SAS_2.4.15.pdf. Accessed 20 Feb 2014.
- 25.Earle CC, Nattinger AB, Potosky AL, Lang K, Mallick R, Berger M, et al. Identifying cancer relapse using SEER-Medicare data. Med Care. 2002;40(8):IV-75–81.Google Scholar
- 26.Gray AM, Clarke PM, Wolstenholme JL, Wordsworth S. Applied methods of cost-effectiveness analysis in healthcare. Oxford: Oxford University Press; 2010.Google Scholar
- 29.Brown ML, Riley GF, Schussler N, Etzioni R. Estimating health care costs related to cancer treatment from SEER-Medicare data. Med Care. 2002;40(8):IV-104–17.Google Scholar
- 30.Medical care—consumer price index; 2013. http://data.bls.gov/timeseries/CUUR0000SAM?output_view=pct_12mths. Accessed 20 Feb 2014.