First-line therapy for metastatic colorectal cancer cost-effective

In metastatic colorectal carcinoma, first-line therapy with oxaliplatin and infusional fluorouracil (FOLFOX) provides substantial benefits at substantial incremental cost – but the protocol’s cost-effectiveness is acceptable within the context of cancer interventions in the US, according to a report in the November 1st issue of Cancer.

“Even highly effective therapy is often associated with relatively high incremental costs,” Dr. Bruce E. Hillner from Virginia Commonwealth University, Richmond, Virginia told Reuters Health. “The costs with newer agents and biological therapy are going up exponentially.” Dr. Hillner and colleagues investigated the incremental cost-effectiveness of FOLFOX compared with the bolus regimen of irinotecan plus fluorouracil/leucovorin (IFL) for the first-line treatment of metastatic colorectal carcinoma. FOLFOX treatment was associated with a 4.4-month increase in mean survival at a cost $29,523 more than IFL per patient, the authors report, resulting in an incremental cost-effectiveness of $80,407 per life-year. FOLFOX was more expensive mainly because of the increased costs of oxaliplatin treatment administration. The delivery costs of FOLFOX chemotherapy were 229% higher than those of IFL bolus administration. Based on the 95% confidence interval for time to progression, the researchers note, the incremental cost-effectiveness of FOLFOX could range from $59,250 to $121,220 per life-year. Incorporating quality-of-life factors into the model increased the incremental cost-effectiveness ratio to $111,890 per quality-adjusted life-year, the report indicates. “The cost-effectiveness model used in the current report estimated that the incremental cost-effectiveness of FOLFOX, compared with IFL, falls into the upper range of commonly accepted oncology interventions in the context of the United States healthcare system,” the authors conclude. “Colorectal cancer is a classic opportunity to consider the incremental costs for incrementally more effective therapy,” Dr. Hillner said. “There are many important questions out there. The barrier is the lack of financial support to do an impartial assessment.” (Source: Cancer 2005;104:1871-1884: Reuters Health: Will Boggs, MD: Oncolink: November 2005.)