ADJUVANT THERAPY FOR STAGE-III COLON-CANCER - ECONOMICS RETURNS TO RESEARCH AND COST-EFFECTIVENESS OF TREATMENT

Background: In 1989, the National Cancer Institute issued a clinical a nnouncement advising physicians of the benefits of combined levamisole and fluorouracil as an adjuvant treatment for patients with stage III colon cancer. Purpose: We have estimated the cost-effectiveness of th e combined treatment and estimated the social return on the National I nstitutes of Health (NIH) research investment that led to this innovat ive cancer treatment. Methods: A computer simulation model, CANTROL, was used to estimate costs and benefits for a population cross-section receiving the adjuvant treatment. A method similar to ''Q-TWiST'' was used to assess the impact of quality-of-life adjustments. Results: Fo r a typical base-line case, the calculated cost-effectiveness is a ver y favorable $2094 per year of life saved. Using a variety of less favo rable assumptions, cost-effectiveness is still less than $5000 per yea r of life saved, again a favorable value. Quality-of-life adjustments have a negligible effect on the cost-effectiveness outcome. The net pr esent value of the return to the NIH research investment is estimated to be $1.66 billion. Conclusions: Under a wide range of reasonable ass umptions, adjuvant therapy for stage III colon cancer appears to be a very cost-effective procedure. The investment in the research that res ulted in this therapy promises to yield a high return.