J. Norum et al., ADJUVANT CHEMOTHERAPY (5-FLUOROURACIL AND LEVAMISOLE) IN DUKES-B AND DUKES-C COLORECTAL-CARCINOMA - A COST-EFFECTIVENESS ANALYSIS, Annals of oncology, 8(1), 1997, pp. 65-70
Background: Adjuvant chemotherapy (5-fluorouracil, levamisole) is now
standard practice in the treatment of Dukes' B and C coloretal carcino
ma (CRC), and this has increased the financial burden on health care s
ystems world-wide. Patients and methods: Between 1993 and 1996, 95 pat
ients in northern Norway were included in a national randomised CRC st
udy, and assigned to surgery plus adjuvant chemotherapy or surgery alo
ne. In April 1996, 94 of the patients were evaluable and 82 were still
alive. The total treatment costs (hospital stay, surgery, chemotherap
y, administrative and travelling costs) were calculated. A questionnai
re was mailed to all survivors for assessment of the quality of their
lives (QoL) (EuroQol questionnaire, a simple QoL-scale, global QoL-mea
sure of the EORTC QLQ-C30), and 62 of them (76%) responded. Results: A
djuvant chemotherapy in Dukes' B and C CRC raised the total treatment
costs by pound 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 th
erapy ranging from 5% to 15%, we calculated the cost of one gained qua
lity-adjusted life-year (QALY) to be between pound 4,800 and pound 16,
800. Conclusion: Using a cut-off point level of pound 20,000 per QALY,
adjuvant chemotherapy in CRC appears to be cost-effective only when t
he improvement in 5-year survival is greater than or equal to 5%. Adju
vant chemotherapy does not affect short-term QoL.