Cost-effectiveness of 12 months of capecitabine as adjuvant chemotherapy for stage III colon cancer: preplanned cost-effectiveness analysis of the JFMC37-0801 study

Hidetoshi Shibahara (), Takeru Shiroiwa, Megumi Ishiguro, Masato Nakamura, Junichi Hasegawa, Shigeki Yamaguchi, Yuriko Masuda, Junichi Sakamoto, Naohiro Tomita and Takashi Fukuda
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Hidetoshi Shibahara: CRECON Medical Assessment Inc.
Takeru Shiroiwa: National Institute of Public Health (NIPH)
Megumi Ishiguro: Tokyo Medical and Dental University Medical Hospital
Masato Nakamura: Aizawa Hospital
Junichi Hasegawa: Osaka Rosai Hospital
Shigeki Yamaguchi: Saitama Medical University International Medical Center
Yuriko Masuda: CRECON Medical Assessment Inc.
Junichi Sakamoto: Tokai Central Hospital
Naohiro Tomita: Toyonaka Municipal Hospital
Takashi Fukuda: National Institute of Public Health

The European Journal of Health Economics, 2022, vol. 23, issue 7, No 6, 1159-1171

Abstract: Abstract Objectives We evaluated the cost-effectiveness of a 12-month regimen of oral capecitabine versus a standard 6-month regimen as postoperative adjuvant chemotherapy for stage III colon cancer. Methods We utilized patient-level data from a multi-institutional randomized controlled trial (JFMC37-0801) that investigated prolonged oral fluoropyrimidine monotherapy. The analysis considered three health states: stable disease, post-metastasis, and death. A parametric statistical model with a cure model was used to estimate the survival curve. The analysis was conducted from the Japanese public healthcare payer’s perspective, considering only direct medical costs. A lifetime horizon was used, with a discount rate of 2% for both cost and health outcomes. Health outcomes were evaluated in terms of quality-adjusted life-years (QALYs). Results The estimated cure rates for colon cancer were 0.726 [95% confidence interval (CI) 0.676–0.776] and 0.694 (95% CI 0.655–0.733) with the 12- and 6-month regimens, respectively; and the estimated 5-year relapse-free survival rates were 74.4% and 69.8%, respectively. The estimated lifetime cost for 12 months of capecitabine was JPY 3.365 million (USD 31,159), compared with JPY 3.376 million (USD 31,262) for 6 months. The estimated QALY were 12.48 and 11.77 for the 12- and 6-month regimens, respectively. Thus, the 12-month capecitabine regimen was dominant. Using a willingness-to-pay threshold of JPY 5 million per QALY, we determined a 97.4% probability that the 12-month capecitabine regimen is more cost-effective than the 6-month regimen. Conclusions Twelve months of capecitabine is the favorable option for postoperative adjuvant chemotherapy for stage III colon cancer from the perspective of cost-effectiveness.

Keywords: Cost-effectiveness; Capecitabine; Adjuvant chemotherapy; Colon cancer; JFMC37-0801 study (search for similar items in EconPapers)
JEL-codes: I19 (search for similar items in EconPapers)
Date: 2022
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DOI: 10.1007/s10198-021-01418-6

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