Abstract
Background
Dosing chemotherapy based on BSA results in marked interindividual variability in
drug exposure. A randomized trial showed increased OS and decreased toxicity with
PK-guided compared with BSA-based 5-FU dosing in patients with mCRC. The objective
of this study was to compare the cost effectiveness of PK-based 5-FU dosing with BSA-based
5-FU dosing in patients with mCRC receiving FOLFOX (5-FU, leucovorin, and oxaliplatin).
Materials and Methods
We developed a Markov model to evaluate the cost effectiveness of PK FOLFOX compared
with BSA FOLFOX. Progression risks and cause-specific mortality were extrapolated
from the fitted survival models. Costs for administration and management of adverse
events were estimated based on 2013 Medicare reimbursement rates and average sale
prices.
Results
PK FOLFOX provided 2.03 QALYs at a cost of $50,205 compared with BSA FOLFOX, which
provided 1.46 QALYs at a cost of $37,173. The incremental cost-effectiveness ratio
(ICER) was $22,695 per QALY. The ICER remained < $50,000 per QALY in all univariate
and multivariate sensitivity analyses.
Conclusion
At a $50,000 per QALY threshold, PK FOLFOX is cost effective for mCRC. Because of
the cost effectiveness profile and OS advantage with PK FOLFOX, it should be evaluated
further in comparative effectiveness studies.
Keywords
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Article info
Publication history
Published online: September 18, 2014
Accepted:
September 10,
2014
Received:
July 8,
2014
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
