Colorectal cancer cost-effectiveness

New techniques must be assessed with respect to efficiency and cost-effectiveness in comparison to already existing ones. So far only a few cost-effective analyses of management of recurrent colorectal cancer based on decision analysis models have been published. Cost calculations of two studies were based on US Medicare reimbursement rates [32-34], whereas one othereconomic analysis was performed from the French national health insurance s perspective [35]. 

K.C. Park, J. Schwimmer, J.E. Shepherd, M.E. Phelps, J.R. Czernin, C. Schiepers, S.S. Gambhir, Decision analysis for the cost-effective management of recurrent colorectal cancer, Ann. Surg. 233(3) (2001) 310-319. 

C. Levy-Piedbois, I. Durand-Zaleski, H. Juhel, C. Schmitt, A. Bellanger, P. Piedbois, Cost-effectiveness of second-line treatment with irinotecan or infusional 5-fluorouracil in metastatic colorectal cancer, Ann. Oncol. 11 (2000) 157-161. 

Where expectation is confined to palliation in terms of modest life prolongation of less certain quality, then the benefits and costs of treatment must be considered carefully. Preferably, palliative treatments should involve low risk of serious side effects, e.g. 5-fluorouracil-based chemotherapy for advanced colorectal cancer is well tolerated by most patients while improving survival by around 6-9 months. 

Frazier AL, Colditz GA, Fuchs CS, Kuntz KM. Cost-effectiveness of screening for colorectal cancer in the general population. JAMA. 2000 284 1954-61. 

In the absence of the ability of a specific treatment to demonstrate improved survival, important outcome measures should include the effects of the treatment on patient symptoms, daily activities and performance statns, and other quality-of-life indicators, as well as progression-free snrvival and time to treatment failure. Because metastatic colorectal cancer is incurable, a specific decision regarding an individual patient s care will ultimately be required this should be based on a careful assessment of the balance between risks associated with treatment (or lack thereof) and benefits of treatment. Effort should also be made to ensure that the costs of screening, diagnostic tests, treatments, and procednres for colorectal cancer are consistent with their value in improving patient outcomes. 

Schrag D, Weeks J. Costs and cost-effectiveness of colorectal cancer prevention and therapy. Semin Oncol 1999 26 561-568. 

Suleiman, S., Rex, D.K., and Sonnenberg, A., Chemoprevention of colorectal cancer by aspirin a cost-effectiveness analysis. Gastroenterology, 122, 78-84, 2002. 

In the average-risk general population, yearly FOBT starting from the age of 50 years is cost-effective in reducing colorectal cancer mortality between 18 and 33% (Mandel et al. 1993 Mandel et al. 1999 Mandel et al. 2000 Kronborg et al. 1996 Hardcastle et al. 1996). However, FOBT has a low sensitivity (20% for adenomas, 40% for cancers) and compliance is low if the test is proposed on a yearly basis. 

Fusai G, Davidson BR (2003b) Management of colorectal liver metastases. Colorectal Dis 5 2-23 Gazelle GS, Hunink MG, Kuntz KM, et al (2003) Cost-effectiveness of hepatic metastasectomy in patients with metastatic colorectal carcinoma a state-transition Monte Carlo decision analysis. Ann Surg 237 544-555 Gehan EA, Tefft MC (2000) Will there be resistance to the RECIST (response evaluation criteria in solid tumors) J Natl Cancer Inst 92 179-181... 

FU has been extensively used in the treatment of skin cancers and a variety of solid tumours, such as breast, colorectal and gastric cancers, usually via intravenous (i.v.) administration. Although this route is generally the most efficient and the least toxic, it is costly and inconvenient [87], Furthermore, treatment of cancer with 5-FU has been found to cause neurotoxic and cardiotoxic side effects. Toxicity also derives from the lack of selectivity of the drug towards tumours, and resistance can occur if the cell produces excess of dump, for competing with the drug in the active site [88]. 

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