Adjuvant chemotherapy in patients with resectable stage III colon cancer: lifetime cost-effectiveness and cost-utility analysis

Our study was aimed at determining the values of cost, survival, and quality-adjusted survival in patients with resectable colon cancer receiving adjuvant chemotherapy with levamisole and fluorouracil. To quantify quality-adjusted lifetime survival, we employed a combined method utilizing both the Q-TWIST approach and the Gompertz technique. This combined method was used to assess the incremental ratios of cost-effectiveness and costutility for chemotherapy with levamisole + fluorouracil as compared with no adjuvant treatment. The clinical data included in our study were obtained from a long-term controlled trial involving 304 patients given adjuvant treatment and 315 controls. Cost data (including 3% discount rate per annum) were derived from drug acquisition costs and costs related to fluorouracil administration. Our results showed that in patients with resectable Stage III colon cancer, adjuvant chemotherapy with fluorouracil + levamisole improved life expectancy by 284 discounted years for every 100 patients and quality-adjusted survival by 269 discounted QALYs for every 100 patients. After estimating a lifetime incremental cost of $403,730 for every 100 patients, the incremental cost-effectiveness ratio was calculated as $1,422 per life year gained (95% CI: $901 to $2,639). The cost-utility ratio was $1,501 per QALY gained. We conclude that the adjuvant chemotherapy with fluorouracil + levamisole in patients with stage III colon cancer has an extremely favorable pharmacoeconomic profile.