Clinical Practice Guidelines - National Health and Medical Research ...

Study Country Study questions Conclusion
Cunningham
et al 113
United
Kingdom
Poston et al 114 United
Kingdom
Koperna and
Semmler 115
Focan 116
276
Comparison of
irinotecan + 5-FU+
FA vs 5-FU+FA
alone as 1st-line
treatment
Comparison of
oxaliplatin + 5-FUFA
vs 5-FU/FA alone
Austria Comparison of
oxaliplatin + FU/LV
vs FU/LV alone for
stage III patients
Belgium Comparison of 5-
FU/FA + oxaliplatin
administered either
as standard (flat arm
A) or
chronomodulated
(arm B) drug
infusions
The prevention, early detection and management of colorectal cancer
Irinotecan + 5-FU/FA is cost-effective
compared to FU/FA alone, with ICER =
₤14,794 ($A40,452)/LYG. Sensitivity
analysis confirms the results are robust.
Oxaliplatin + 5-FU/FA increases
resection rates compared to 5-FU/FA at
an acceptable cost (ICER = ₤11,985
[$A31,182]/LYG). Sensitivity analysis
indicates an ICER range of ₤5489–15,624
($A14,560–41,471), with variations to
resection rates, survival rates and
discounting.
Oxaliplatin + FU/LV is cost-effective for
stage III patients. Even under the most
conservative scenario, (20% increase in
mortality and recurrence reduction rates),
compared to best supportive care, LYG
(undiscounted and discounted) for FU/LV
and for oxaliplatin + FU/LV was 51 vs
62; 41.8 vs 50.8. Undiscounted and
discounted ICERs/LYG were $US5352,
$US6503 ($A7907, $A9608); $US7425,
$US8865 ($A10,970, $A13,098); $US9920,
$US10,956 ($A14,656, $A16,187); and
$US10,609, $US12,485 ($A15,674
$A18,446).
Costs are basically equivalent. Higher
treatment costs for chronomodulated drug
infusion are counterbalanced by fewer
complications and shorter LOS. Costs are
also less for melodie pump. For flat arm
A and arm B (intelliject and melodie
pump), costs/course were 131,340BEF,
107,176 BEF, 134,668 BEF and 110,592
BEF ($A246,129, $A200,846, $A252,366,
A207,248).