Health economic evidence for adjuvant chemotherapy in stage II and III colon cancer: a systematic review

To, Yat Hang; Gibbs, Peter; Tie, Jeanne; IJzerman, Maarten; Degeling, Koen

doi:10.1186/s12962-023-00422-2

Cost Effectiveness and Resource Allocation

Table 2 Summary of the study characteristics and key findings of the final sample of economic evaluations

From: Health economic evidence for adjuvant chemotherapy in stage II and III colon cancer: a systematic review

	Stage	Publication	Country (currency)	Economic perspective	Evaluation type	Modelling technique	Time horizon	Discount rate (%)	Treatment strategies (experimental vs. control)	Health outcomes	Impact of experimental vs. control strategy on cost	Impact of experimental vs. control strategy on health outcomes	Authors’ cost-effectiveness judgement	WTP
AC vs. no AC	II	Ayaci, 2013 [18]	USA (USD)	Healthcare payer	CUA	Markov	5 years	3	5FU vs. no AC	QALY	Increase	Increase	Cost effective	50,000
	II	Ayaci, 2013 [18]	USA (USD)	Healthcare payer	CUA	Markov	5 years	3	FOLFOX vs. no AC	QALY	Increase	Increase	Not cost-effective	50,000
	III	Smith, 1993 [19]	Australia (AUD)	Healthcare payer	CUA	Decision tree	20 years	5	5FU + LV vs. no AC	QALY	Increase	Increase	Author did not provide conclusion	Not reported
		Brown, 1994 [20]	USA (USD)	Societal	CEA	Markov	30 years	6	5FU + Leva vs. no AC	LY	Increase	Increase	Cost-effective	50,000
		Lairson, 2014 [21]	USA (USD)	Healthcare payer	CUA	Patient level data	Lifetime	3	5FU + LV vs. no AC	QALY	Increase	Increase	Cost-effective	100,000
		Lairson, 2014 [21]	USA (USD)	Healthcare payer	CUA	Patient level data	Lifetime	3	FOLFOX vs. no AC	QALY	Increase	Increase	Cost-effective	100,000
	II and III	Norum, 1997 [22]	Norway (BP)	Healthcare payer	CUA	Patient level data	Lifetime	5	5FU + Leva vs. no AC	QALY	Increase	Increase	Cost effective	20,000
	II and III	Michel, 1999 [23]	France (USD)	Healthcare payer	CEA	Decision tree	5 years	No discount	AC in stage II and III vs. AC in stage III only	No. of surviving patients	Increase	Increase	Cost-effective	10,000
Oral vs. IV chemotherapy	III	Cassidy, 2006 [24]	UK (BP)	Societal	CEA, CUA	PSA	Lifetime	1.5 (cost); 6 (effect)	Capecitabine vs. 5FU	LM, QALM	Decrease	Increase	Capecitabine dominates 5FU	Not reported
		Eggington, 2006 [25]	UK (BP)	Healthcare payer	CEA, CUA	Markov	50 years	6 (cost); 1.5 (effect)	Capecitabine vs. 5FU	LY, QALY	Decrease	Increase	Capecitabine dominates 5FU	20,000
		Ho, 2006 [26]	Canada (CAD)	Societal	CMA	Decision tree	5 years	NR	XELOX vs. FOLFOX	N/A	Decrease	N/A	N/A	N/A
		Douillard, 2007 [27]	France (Euro)	Healthcare payer	CC	Decision tree	3 years	No discount	Capecitabine vs. 5FU	Relapse-free survival	Decrease	Increase	Capecitabine dominates 5FU	Not reported
		DiConstanzo, 2008 [28]	Italy (Euro)	Healthcare payer	CEA, CUA	PSA	10 years	3.5	Capecitabine vs. 5FU	LM, QALM	Decrease	Increase	Capecitabine dominates 5FU	Not reported
		Goerner, 2009 [29]	Germany (Euro)	Healthcare payer	Costing analysis	Decision tree	6 months	NR	Capecitabine vs. 5FU	N/A	Decrease	N/A	N/A	N/A
		Shiroiwa, 2009 [30]	Japan (Yen)	Healthcare payer	CUA	Markov	30 years	3	Capecitabine vs. 5FU	QALY	Decrease	Increase	Capecitabine dominates 5FU	0
		Hsu, 2011 [31]	UK (BP)	Healthcare payer	CUA	PSA	10 years	3	Capecitabine vs. 5FU	QALM	Decrease	Increase	Capecitabine dominates 5FU	Not reported
		Xie, 2013 [32]	China (USD)	Societal	Costing analysis	Patient level data	6 months	No discount	CAPOX vs. FOLFOX	N/A	Decrease	N/A	N/A	N/A
		Soni, 2014 [33]	US (USD)	Healthcare payer	CUA	Markov	5 years	3	Capecitabine vs. 5FU	QALY	Increase	Decrease	5FU dominates Capecitabine	100,000
		Chen, 2015 [34]	Taiwan (NT)	Societal	CUA	Patient level data	28 weeks	No discount	Capecitabine ± oxaliplatin vs. 5FU ± oxaliplatin	Health-related QOL scores	Decrease	No difference	Cost-effective	Not reported
		Lerdkiattikorn, 2015 [35]	Thailand (Baht)	Societal	CUA	Markov	99 years	3	Capecitabine vs. 5FU	QALY	Increase	Increase	Not cost effective	300,000
		Lin, 2015 [36]	Taiwan (NT)	Societal	Costing analysis	Patient level data	25 months	No discount	Capecitabine vs. 5FU	Health-related QOL scores	Decrease	No difference	Cost saving	N/A
		vanGils, 2015 [37]	Netherlands (Euro)	Healthcare sector	Costing analysis	Patient level data	6 months	No discount	Capecitabine vs. 5FU	N/A	Decrease	N/A	N/A	N/A
	II and III	Murad, 1997 [38]	Brazil & Argentina (Real)	Healthcare payer	CMA	Decision Tree	18 months	NR	UFT + LV vs. 5FU + LV	N/A	Decrease	N/A	N/A	N/A
		Manidakis, 2009 [39]	Greece (Euro)	Societal	CMA	Patient level data	12 months	NR	CAPOX vs. FOLFOX	N/A	Decrease	N/A	N/A	N/A
		Wen, 2014 [40]	China (USD)	Societal	CUA	Markov	6 months	NR	CAPOX vs. FOLFOX	QALY	Decrease	Decrease	Cost-effective	17,815 (3 × GDP)
		Hsu, 2019 [41]	Taiwan (USD)	Healthcare payer	CMA	Decision Tree	6 months	NR	UFT + LV vs. 5FU + LV	N/A	Decrease	Increase	N/A	N/A
Oxaliplatin vs. no oxaliplatin	II	Ayaci,, 2013 [18]	USA (USD)	Healthcare payer	CUA	Markov	5 years	3	FOLFOX vs. 5FU + LV	QALY	Increase	Increase	Not cost effective	50,000
	III	Pandor, 2006 [42]	UK (BP)	Healthcare payer	CEA, CUA	Markov	50 years	6 (cost); 1.5 (effect)	FOLFOX vs. 5FU + LV	QALY	Increase	Increase	Cost-effective	20,000
									FOLFOX vs. 5FU + LV		Increase	Increase	Cost-effective
									FOLFOX vs. Capecitabine		Increase	Increase	Cost-effective
		Eggington, 2006 [25]	UK (BP)	Healthcare payer	CEA, CUA	Markov	50 years	6 (cost); 1.5 (effect)	FOLFOX vs. 5FU + LV	LY, QALY	Increase	Increase	Cost-effective	20,000
		Aballea, 2007 [43]	UK (BP)	Healthcare payer	CUA	PSA	50 years	3.5	FOLFOX vs. 5FU + LV	QALY	Increase	Increase	Cost effective	30,000
		Aballea, 2007 [44]	USA (USD)	Healthcare payer	CUA	PSA	50 years	3	FOLFOX vs. 5FU + LV	QALY	Increase	Increase	Cost effective	50 – 100,000
		Goerner, 2009 [29]	Germany (Euro)	Healthcare payer	Costing analysis	Decision tree	6 months	No discount	FOLFOX vs. 5FU + LV	N/A	Increase	N/A	N/A	N/A
		Goerner, 2009 [29]	Germany (Euro)	Healthcare payer	Costing analysis	Decision tree	6 months	No discount	CAPOX vs. 5FU + LV	N/A	Increase	N/A	N/A	N/A
		Attard, 2010 [45]	Canada (CAD)	Healthcare payer	CUA	PSA	50 years	5	FOLFOX vs. 5FU + LV	QALY	Increase	Increase	Cost-effective	Not reported
		Shiroiwa, 2012 [46]	Japan (Yen)	Healthcare payer	CUA	PSA	30 years	3	FOLFOX vs. 5FU + LV	QALY	Increase	Increase	Cost-effective	5 million
		Soni, 2014 [33]	USA (USD)	Healthcare payer	CUA	Markov	5 years	3	FOLFOX vs. 5FU + LV	QALY	Increase	Increase	Cost-effective	100,000
		Soni, 2014 [33]	USA (USD)	Healthcare payer	CUA	Markov	5 years	3	CAPOX vs. 5FU + LV	QALY	Increase	Decrease	5FU dominates CAPOX	100,000
		Lerdkiattikorn, 2015 [35]	Thailand (Baht)	Societal	CUA	Markov	99 years	3	FOLFOX vs. 5FU + LV	QALY	Increase	Increase	Not cost effective	300,000
		vanGils, 2015 [37]	Netherlands (Euro)	Healthcare sector	Costing analysis	Patient level data	6 months	NR	FOLFOX vs. 5FU + LV	N/A	Increase	N/A	N/A	N/A
									FOLFOX vx. Capecitabine	N/A	Increase	N/A	N/A
									CAPOX vs. 5FU + LV	N/A	Increase	N/A	N/A
									CAPOX vs. Capecitabine	N/A	Increase	N/A	N/A
3 M vs. 6 M	II	Jongeneel, 2020 [4]	Netherlands (Euro)	Societal	CUA	Markov	Lifetime	4 (cost); 1.5 (effect)	3 M vs. 6 M FOLFOX	QALY	Decrease	Decrease	Not cost-effective; negative NMB	50,000
	II	Jongeneel, 2020 [4]	Netherlands (Euro)	Societal	CUA	Markov	Lifetime	4 (cost); 1.5 (effect)	3 M vs. 6 M CAPOX	QALY	Decrease	Increase	3 M CAPOX dominates 6 M	50,000
	II and III	Robles-Zurita, 2018 [47]	UK (BP)	Healthcare sector	CUA	PSA	8 years	3.5	3 M vs. 6 M CAPOX	QALY	Decrease	Increase	3 M dominates 6 M	30,000
		Iveson, 2019 [48]	UK (BP)	Healthcare sector	CUA	PSA	8 years	3.5	3 M vs. 6 M AC	QALY	Decrease	Increase	3 M dominates 6 M	30,000
		Hanna, 2021 [6]	Multi-country (USD)	Healthcare sector	CUA, BIA	Patient level data	10 year	3.5	3 M vs. 6 M AC	QALY	Decrease	Increase	Cost effective	42,000
Biomarker	II	Hornberger, 2012 [49]	USA (USD)	Societal	CUA	Markov	Lifetime	3	Oncotype Dx vs. SOC	QALY	Decrease	Increase	Genomic assay dominates SOC	50,000
		Alberts, 2014 [50]	USA (USD)	Healthcare payer	CUA	Markov	Lifetime	3	OncotypeDx vs.SOC	QALY	Decrease	Increase	Genomic assay dominates SOC	50,000
		Jongeneel, 2021 [51]	Netherlands (Euros)	Societal	CUA	Markov	Lifetime	4 (cost); 1.5 (effect)	Biomarker (MSS + BRAF/KRAS) vs. SOC	QALY	Increase	Increase	Cost-effective	50,000
		To, 2021 [5]	Australia (AUD)	Healthcare payer	CUA	Markov	Lifetime	5	ctDNA vs. SOC	QALY	Decrease	Increase	ctDNA dominate SOC	20,000
		Alarid-Escuder, 2021 [52]	USA (USD)	Healthcare payer	CUA	Markov	Lifetime	3	Biomarker (CDX2) vs. no AC	QALY	Increase	Increase	Cost-effective	100,000

3 M 3 month duration of chemotherapy, 6 M 6 month duration of chemotherapy, 5FU 5-fluorouracil, AC adjuvant chemotherapy, AUD Australian Dollars, BIA Budget impact analysis, BP British Pound, CEA cost-effectiveness analysis, CMA cost-minimisation analysis, ctDNA circulating tumour DNA, CUA cost-utility analysis, IV intravenous, LV leucovorin, LY life-years, PSA partitioned survival analysis, NT Taiwan Dollar, NR not reported, QALY Quality-adjusted life years, SOC standard of care, USD United State Dollars

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