COST-EFFECTIVENESS OF ADJUVANT INTRAPORTAL CHEMOTHERAPY IN PATIENTS WITH COLORECTAL-CANCER

Recent studies have shown that the analysis of published survival curv es allows cost-effectiveness evaluations in which two treatments are c ompared with each other in terms of cost per life-year saved. In patie nts with colorectal cancer, the administration of adjuvant intraportal chemotherapy (with mitomycin and fluorouracil) has been reported to i mprove long-term survival in comparison with patients who are not give n this treatment. To assess the pharmacoeconomic profile of this adjuv ant chemotherapy, we carried out an incremental cost-effectiveness ana lysis in which we used the Gompertz model to estimate lifetime patient years gained by patients given this chemotherapy in comparison with c ontrols. Using the data of a published controlled long-term trial invo lving 252 patients treated with intraportal chemotherapy and 253 contr ols who were given no such therapy, we estimated that the adjuvant tre atment improved life expectancy by 89 discounted patient years (or 218 undiscounted patient years) every 100 patients. Cost of chemotherapy was calculated as $107,720 for every 100 patients. On the basis of the se data, the administration of adjuvant intraportal chemotherapy was f ound to imply an incremental cost of $1,210 per discounted life-year s aved or $494 per undiscounted life-year saved. The cost-effectiveness ratio of adjuvant intraportal chemotherapy in patients with colorectal cancer seems to be particularly favorable in comparison with estimate s of cost per life-year saved previously obtained in many other areas of pharmacological intervention. Even though systemic fluorouracil + l evamisole is the form of adjuvant chemotherapy most widely used in the se patients, intraportal chemotherapy has the best cost-effectiveness profile.