, Volume 32, Issue 10, pp 1005–1013 | Cite as

Cost–Utility Analysis of Chemotherapy Regimens in Elderly Patients with Stage III Colon Cancer

  • David R. Lairson
  • Rohan C. Parikh
  • Janice N. Cormier
  • Wenyaw Chan
  • Xianglin L. Du
Original Research Article



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.


Propensity Score Oxaliplatin Veteran Administration Health Propensity Score Match Electronic Supplementary Material Figure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



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.

Supplementary material

40273_2014_180_MOESM1_ESM.docx (808 kb)
Supplementary material 1 (DOCX 808 kb)


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Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • David R. Lairson
    • 1
  • Rohan C. Parikh
    • 1
  • Janice N. Cormier
    • 2
  • Wenyaw Chan
    • 3
  • Xianglin L. Du
    • 1
    • 4
  1. 1.Division of Management, Policy and Community Health, School of Public HealthUniversity of Texas Health Science Center at HoustonHoustonUSA
  2. 2.Division of Surgical Oncology and BiostatisticsUniversity of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.Division of Biostatistics, School of Public HealthUniversity of Texas Health Science Center at HoustonHoustonUSA
  4. 4.Division of Epidemiology, Human Genetics and Environmental Sciences, School of Public HealthUniversity of Texas Health Science Center at HoustonHoustonUSA

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