Cost-Utility Analysis in Adjuvant Treatment of Colon Cancer Staging III (Dukes C)

Abstract

Introduction: The increase on government financial support related to adjuvant treatment of colon cancer staging III in hospitals from the Unified Health System allows the usage of drugs which have not been used before. However, there are no pharmaco-economic studies able to guide managers on choosing the most efficient treatment. Objective: To evaluate the cost-utility ratio among Fluorouracil/Leucovorin (5FU/LV, Mayo Clinic Regimen) versus Capecitabine and 5FU/LV versus Fluorouracil/Leucovorin/Oxaliplatin (FLOX) as adjuvant therapy in colon cancer staging III in a perspective of a public hospital located in Brazil. Method: Efficacy data were extracted from literature and costs from the Hospital Information System of the institution. A Markov Model was used, consisting of 10 cycles of 6 months each and four health states: Anti-neoplastic Therapy, Disease Free, Relapse and Death. A discount rate of 5% was applied to variables. Costs were expressed in Real (R$), the Brazilian currency, and outcomes in Quality Adjusted Life Month (QALM). A one-way sensitivity analysis was performed. Results: Capecitabine and FLO X promote 0.33 and 1.75 incremental QALM compared to 5FU/LV, respectively. The comparison between Capecitabine and 5FU/ LV showed an Incremental Cost-Effectiveness Ratio (ICER) of R$ 13,585.64/QALM, whereas FLOX and 5FU/LV showed an ICER of R$1,007.92/QALM. Sensitivity analysis shows robust findings. Conclusion: Acquisition cost of Capecitabine prevents its use in patients diagnosed with colon cancer stage III in the perspective evaluated. Incremental cost of FLOX is comprehended by government financial support, what favors its incorporation as adjuvant treatment of colon cancer stage III by the Hospital to patients eligible for this protocol.