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Medline ® Abstract for Reference 127

of 'Systemic chemotherapy for nonoperable metastatic colorectal cancer: Treatment recommendations'

127
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Cost-effectiveness analysis of XELOX for metastatic colorectal cancer based on the NO16966 and NO16967 trials.
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Shiroiwa T, Fukuda T, Tsutani K
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Br J Cancer. 2009;101(1):12. Epub 2009 Jun 2.
 
BACKGROUND: The purpose of the study was to evaluate the cost-effectiveness of capecitabine plus oxaliplatin (XELOX) compared with 5-fluorouracil/folinic acid and oxaliplatin (FOLFOX4) as first-line or second-line chemotherapy in patients with metastatic colorectal cancer.
METHODS: On the basis of NO16966 and NO16967 trials, mean costs and effectiveness were calculated from patient-level data. Until the disease progressed, the mean costs were calculated from the perspective of health-care payers in Japan. We estimated mean quality-adjusted progression-free survival days (QAPFSD), considering adverse events and patient preference for chemotherapy regimens. Utility scores were obtained by a web-based survey from general people, randomly sampled from a large panel adjusted for sex and age.
RESULTS: Incremental effectiveness of XELOX as first-line and second-line chemotherapy for colorectal cancer patients was significantly greater. By use of XELOX, patients gained 10.5 QAPFSD from first-line treatment or 11.3 QAPFSD from second-line treatment. Capecitabine plus oxaliplatin (XELOX) was also proven to significantly reduce treatment costs by 3000 euro (JPY 360,000) and 2300 euro (JPY 270,000) for first-line and second-line treatment, respectively. In health-care settings in the United Kingdom, XELOX decreased medical costs for National Health Service by 7600 pound and 3900 pound for patients who received first-line and second-line treatment, respectively.
CONCLUSION: Capecitabine plus oxaliplatin (XELOX) as first-line and second-line chemotherapy was 'dominant'. In terms of effectiveness and cost, XELOX was superior to FOLFOX4.
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Department of Drug Policy and Management, Graduate School of Pharmaceutical Sciences, the University of Tokyo, Tokyo, Japan. t.shiroiwa@gmail.com
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