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Medline ® Abstract for Reference 128

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

Cost-effectiveness analysis of XELOX for metastatic colorectal cancer based on the NO16966 and NO16967 trials.
Shiroiwa T, Fukuda T, Tsutani K
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.
Department of Drug Policy and Management, Graduate School of Pharmaceutical Sciences, the University of Tokyo, Tokyo, Japan. t.shiroiwa@gmail.com