A study published in the Journal of Managed Care & Specialty Pharmacy has shown that outcomes for metastatic colon cancer and the cost of care can both vary significantly based on which therapies are used in first- and second-line treatment.
Thanks to the development of new therapeutic agents and treatment strategies, the outcomes of patients with metastatic colon cancer have improved substantially over the last few decades; however these new developments have also come with a significant rise in costs.
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To gain a better understanding of how cost and survival can change based on which agents are administered in the first and second lines of care, researchers led by Andinet Woldemichael, PhD, University of Maryland (Baltimore, MD), used the Surveillance, Epidemiology and End Results (SEER) cancer registry to look at the records of elderly patients diagnosed with metastatic colon cancer between 2003 and 2009.
Overall, researchers found that patients who received second-line treatment survived more than 6 months longer than those who did not (16.9 months vs 10.2 months, respectively). However, mean incremental survival varied from 4 months to 9 months depending upon whether fluorouracil was used alone or in conjunction with leucovorin, irinotecan, oxaliplatin, or other agents during first-line treatment.
In terms of cost, mean incremental cost associated with the receipt of second-line treatment was $60,231, but also varied significantly based on which regimen was administered in first-line treatment. The incremental cost-effectiveness ratios per life-year gained associated with these regimens were $97,368 (irinotecan); $110,621 (fluorouracil/leucovorin); $130,689 (oxaliplatin); and $247,951 (other combinations).
From these data, researchers concluded that the cost-effectiveness of second-line treatment may depend on what regimen was administered as the first line of care.
However, they did also note some limitations of the study, most significantly the fact that the dataset was nonrandomized, which could have lead to bias or censoring in measurement; although, they added that SEER data are commonly used in health economic analyses.
