Adjuvant chemotherapy (5-fluorouracil and levamisole) in Dukes' B and C colorectal carcinoma. A cost-effectiveness analysis

• Published in: Annals of oncology Vol. 8; no. 1; pp. 65 - 70
• Main Authors: Norum, J., Vonen, B., Olsen, J. A., Revhaug, A.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-01-1997
• Subjects: adjuvant therapy; Adult; Aged; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - economics; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Chemotherapy; Chemotherapy, Adjuvant - economics; colorectal carcinoma; Colorectal Neoplasms - drug therapy; Colorectal Neoplasms - economics; Colorectal Neoplasms - mortality; Colorectal Neoplasms - pathology; Colorectal Neoplasms - surgery; Colostomy; Cost-Benefit Analysis; cost-effectiveness analysis; Female; Fluorouracil - administration & dosage; Fluorouracil - economics; Follow-Up Studies; Health Care Costs; Humans; Length of Stay - economics; Levamisole - administration & dosage; Levamisole - economics; Male; Medical sciences; Middle Aged; Norway - epidemiology; Pharmacology. Drug treatments; Quality of Life; Survival Analysis; Survival Rate; Travel - economics; Norway; Europe; Antineoplastic agent; Human; Drug combination; Rectal disease; Carcinoma; Fluoropyrimidine derivatives; Levamisole; Adjuvant treatment; Malignant tumor; Colonic disease; Chemotherapy; Surgery; Rectum; Intestinal disease; Advanced stage; Colon; Public health; Cost efficiency analysis; Fluorouracil
• ISSN: 0923-7534; 1569-8041
• DOI: 10.1023/A:1008265905933

Background: Adjuvant chemotherapy (5-fluorouracil, levamisole) is now standard practice in the treatment of Dukes' B and C coloretal carcinoma (CRC), and this has increased the financial burden on health care systems world-wide. Patients and methods: Between 1993 and 1996, 95 patients in northern Norway were included in a national randomised CRC study, and assigned to surgery plus adjuvant chemotherapy or surgery alone. In April 1996, 94 of the patients were evaluable and 82 were still alive. The total treatment costs (hospital stay, surgery, chemotherapy, administrative and travelling costs) were calculated. A questionnaire was mailed to all survivors for assessment of the quality of their lives (QoL) (EuroQol questionnaire, a simple QoL-scale, global QoL-measure of the EORTC QLQ-C30), and 62 of them (76%) responded. Results: Adjuvant chemotherapy in Dukes' B and C CRC raised the total treatment costs by £3,360. The median QoL was 0.83 (0–1 scale) in both arms. Employing a 5% discount rate and an improved survival of adjuvant therapy ranging from 5% to 15%, we calculated the cost of one gained quality-adjusted lifeyear (QALY) to be between £4,800 and £16,800. Conclusion: Using a cut-off point level off £20,000 per QALY, adjuvant chemotherapy in CRC appears to be cost-effective only when the improvement in 5-year survival is ij 5%. Adjuvant chemotherapy does not affect short-term QoL.