Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY.
Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
JCO Glob Oncol. 2021 Dec;7:1730-1741. doi: 10.1200/GO.21.00279.
Cancer incidence is rising in low- and middle-income countries, where resource constraints often complicate therapeutic decisions. Here, we perform a cost-effectiveness analysis to identify the optimal adjuvant chemotherapy strategy for patients with stage III colon cancer treated in South African (ZA) public hospitals.
A decision-analytic Markov model was developed to compare lifetime costs and outcomes for patients with stage III colon cancer treated with six adjuvant chemotherapy regimens in ZA public hospitals: fluorouracil, leucovorin, and oxaliplatin for 3 and 6 months; capecitabine and oxaliplatin (CAPOX) for 3 and 6 months; capecitabine for 6 months; and fluorouracil/leucovorin for 6 months. Transition probabilities were derived from clinical trials to estimate risks of toxicity, disease recurrence, and survival. Societal costs and utilities were obtained from literature. The primary outcome was the incremental cost-effectiveness ratio in international dollars (I$) per disability-adjusted life-year (DALY) averted, compared with no therapy, at a willingness-to-pay (WTP) threshold of I$13,006.56.
CAPOX for 3 months was cost-effective (I$5,381.17 and 5.74 DALYs averted) compared with no adjuvant chemotherapy. Fluorouracil, leucovorin, and oxaliplatin for 6 months was on the efficiency frontier with 5.91 DALYs averted but, with an incremental cost-effectiveness ratio of I$99,021.36/DALY averted, exceeded the WTP threshold.
In ZA public hospitals, CAPOX for 3 months is the cost-effective adjuvant treatment for stage III colon cancer. The optimal strategy in other settings may change according to local WTP thresholds. Decision analytic tools can play a vital role in selecting cost-effective cancer therapeutics in resource-constrained settings.
癌症发病率在中低收入国家呈上升趋势，而这些国家的资源有限，往往使治疗决策变得复杂。在这里，我们进行了一项成本效益分析，以确定在南非（ZA）公立医院治疗 III 期结肠癌患者的最佳辅助化疗策略。
我们开发了一个决策分析马尔可夫模型，以比较在 ZA 公立医院接受以下六种辅助化疗方案治疗的 III 期结肠癌患者的终生成本和结果：氟尿嘧啶、亚叶酸钙和奥沙利铂治疗 3 个月和 6 个月；卡培他滨和奥沙利铂（CAPOX）治疗 3 个月和 6 个月；卡培他滨治疗 6 个月；氟尿嘧啶/亚叶酸钙治疗 6 个月。转移概率来自临床试验，以估计毒性、疾病复发和生存风险。社会成本和效用来自文献。主要结果是与无治疗相比，以每避免一个残疾调整生命年（DALY）的增量成本效益比（ICER）表示，在愿意支付（WTP）阈值为 13006.56 国际元（I$）时，无治疗的增量成本效益比。
与无辅助化疗相比，CAPOX 治疗 3 个月具有成本效益（避免了 5381.17 国际元和 5.74 个 DALY）。氟尿嘧啶、亚叶酸钙和奥沙利铂治疗 6 个月虽然处于效率边界，但避免了 5.91 个 DALY，但增量成本效益比为 99021.36 国际元/DALY，超过了 WTP 阈值。
在 ZA 公立医院，CAPOX 治疗 3 个月是 III 期结肠癌的有效辅助治疗方法。在其他情况下，最佳策略可能会根据当地的 WTP 阈值而变化。决策分析工具在资源有限的环境中选择具有成本效益的癌症治疗方法方面可以发挥重要作用。
