Lairson David R, Parikh Rohan C, Cormier Janice N, Chan Wenyaw, Du Xianglin L
Division of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, 1200 Herman Pressler Drive, Houston, TX, 77030, USA,
Pharmacoeconomics. 2014 Oct;32(10):1005-13. doi: 10.1007/s40273-014-0180-8.
Chemotherapy prolongs survival for stage III colon cancer patients but community-level evidence on the effectiveness and cost effectiveness of treatment for elderly patients is limited. Comparisons were between patients receiving no chemotherapy, 5-fluorouracil (5-FU), and FOLFOX (5-FU + oxaliplatin).
A retrospective cohort study was conducted using the Surveillance Epidemiology, and End Results (SEER)-Medicare linked database. Patients (≥65 years) with American Joint Committee on Cancer stage III colon cancer at diagnosis in 2004-2009 were identified. The 3-way propensity score matched sample included 3,534 patients. Effectiveness was measured in life-years and quality-adjusted life-years (QALYs). Medicare costs (2010 US dollars) were estimated from diagnosis until death or end of study.
FOLFOX patients experienced 6.06 median life-years and 4.73 QALYs. Patients on 5-FU had 5.75 median life-years and 4.50 median QALYs, compared to 3.42 and 2.51, respectively, for the no chemotherapy patients. Average total healthcare costs ranged from US$85,422 for no chemotherapy to US$168,628 for FOLFOX. Incremental cost-effectiveness ratios (ICER) for 5-FU versus no chemotherapy were US$17,131 per life-year gained and US$20,058 per QALY gained. ICERs for FOLFOX versus 5-FU were US$139,646 per life-year gained and US$188,218 per QALY gained. Results appear to be sensitive to age, suggesting that FOLFOX performs better for patients 65-69 and 80+ years old while 5-FU appears most effective and cost effective for the age groups 70-74 and 75-79 years.
FOLFOX appears more effective and cost effective than other strategies for colon cancer treatment of older patients. Results were sensitive to age, with ICERs exhibiting a U-shaped pattern.
化疗可延长III期结肠癌患者的生存期，但关于老年患者治疗效果及成本效益的社区层面证据有限。比较了未接受化疗、接受5-氟尿嘧啶（5-FU）以及FOLFOX（5-FU+奥沙利铂）治疗的患者。
利用监测、流行病学及最终结果（SEER）-医疗保险链接数据库进行了一项回顾性队列研究。确定了2004 - 2009年诊断为美国癌症联合委员会III期结肠癌的患者（≥65岁）。三向倾向评分匹配样本包括3534名患者。疗效通过生命年和质量调整生命年（QALY）来衡量。从诊断到死亡或研究结束估算医疗保险费用（2010年美元）。
接受FOLFOX治疗的患者中位生命年为6.06，QALY为4.73。接受5-FU治疗的患者中位生命年为5.75，中位QALY为4.50，而未接受化疗的患者分别为3.42和2.51。平均总医疗费用从未接受化疗的85,422美元到FOLFOX的168,628美元不等。5-FU与未接受化疗相比，每获得一个生命年的增量成本效益比（ICER）为17,131美元，每获得一个QALY的ICER为20,058美元。FOLFOX与5-FU相比，每获得一个生命年的ICER为139,646美元，每获得一个QALY的ICER为188,218美元。结果似乎对年龄敏感，表明FOLFOX对65 - 69岁和80岁以上的患者效果更好，而5-FU对70 - 74岁和75 - 79岁年龄组似乎最有效且成本效益最高。
对于老年患者的结肠癌治疗，FOLFOX似乎比其他策略更有效且成本效益更高。结果对年龄敏感，ICER呈U形模式。
