Clinical Study
British Journal of Cancer (2009) 101, 12–18. doi:10.1038/sj.bjc.6605114 www.bjcancer.com
Published online 2 June 2009
Cost-effectiveness analysis of XELOX for metastatic colorectal cancer based on the NO16966 and NO16967 trials
T Shiroiwa1, T Fukuda2 and K Tsutani1
- 1Department of Drug Policy and Management, Graduate School of Pharmaceutical Sciences, the University of Tokyo, Tokyo 113-0033, Japan
- 2Department of Health Economics and Epidemiology Research, School of Public Health, the University of Tokyo, Tokyo 113-0033, Japan
Correspondence: T Shiroiwa, Department of Drug Policy and Management, Graduate School of Pharmaceutical Sciences, the University of Tokyo, Yakugaku-toshokan 4F, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; E-mail: t.shiroiwa@gmail.com
Received 29 January 2009; Revised 6 May 2009; Accepted 6 May 2009; Published online 2 June 2009.
Abstract
Background:
The purpose of the study was to evaluate the cost-effectiveness of capecitabine plus oxaliplatin (XELOX) compared with 5-fluorouracil/folinic acid and oxaliplatin (FOLFOX4) as first-line or second-line chemotherapy in patients with metastatic colorectal cancer.
Methods:
On the basis of NO16966 and NO16967 trials, mean costs and effectiveness were calculated from patient-level data. Until the disease progressed, the mean costs were calculated from the perspective of health-care payers in Japan. We estimated mean quality-adjusted progression-free survival days (QAPFSD), considering adverse events and patient preference for chemotherapy regimens. Utility scores were obtained by a web-based survey from general people, randomly sampled from a large panel adjusted for sex and age.
Results:
Incremental effectiveness of XELOX as first-line and second-line chemotherapy for colorectal cancer patients was significantly greater. By use of XELOX, patients gained 10.5 QAPFSD from first-line treatment or 11.3 QAPFSD from second-line treatment. Capecitabine plus oxaliplatin (XELOX) was also proven to significantly reduce treatment costs by 
3000 (JPY 360 000) and 2300 (JPY 270 000) for first-line and second-line treatment, respectively. In health-care settings in the United Kingdom, XELOX decreased medical costs for National Health Service by £7600 and £3900 for patients who received first-line and second-line treatment, respectively.
Conclusion:
Capecitabine plus oxaliplatin (XELOX) as first-line and second-line chemotherapy was 'dominant'. In terms of effectiveness and cost, XELOX was superior to FOLFOX4.
Keywords:
cost-effectiveness analysis, capecitabine, colorectal cancer, FOLFOX
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