Economic evaluation of personalized vs. standard dosing of 5‐fluorouracil in first‐line chemotherapy for metastatic colorectal cancer in Australia

Author:

Erku Daniel1ORCID,Martin Jennifer H.2,Michael Michael34,Galettis Peter25,Scuffham Paul1

Affiliation:

1. Centre for Applied Health Economics Griffith University Nathan QLD Australia

2. The University of Newcastle Hunter Medical Research Institute New Lambton New South Wales Australia

3. Peter MacCallum Cancer Centre Melbourne Victoria Australia

4. Sir Peter MacCallum Department of Oncology The University of Melbourne Melbourne Victoria Australia

5. Centre for Drug Repurposing & Medicines Research, School of Medicine and Public Health, Faculty of Health, Medicine & Wellbeing The University of Newcastle Callaghan NSW Australia

Abstract

AimsUsing pharmacokinetics (PK)‐guided 5‐fluorouracil (5‐FU) for metastatic colorectal cancer (mCRC) improves overall survival (OS) and decreases toxicity, yet its value for money in the Australian setting is unknown. Our study assesses the cost‐effectiveness of PK vs. body surface area (BSA) dosing of 5‐FU for patients with mCRC.MethodsWe developed a semi‐Markov model with four health states to compare PK‐guided dosing within a FOLFOX regimen vs. BSA‐guided dosing for mCRC patients from an Australian healthcare system perspective. Transition probabilities were derived from fitted survival models, with utility values obtained directly from published studies. We calculated direct healthcare costs, quality‐adjusted life years (QALYs) and incremental cost‐effectiveness ratios (ICERs), and included both one‐way and probabilistic sensitivity analyses.ResultsBSA‐guided FOLFOX provided 1.291 QALYs at a cost of $36 379, compared with PK‐guided FOLFOX which delivered 1.751 QALYs at a cost of $32 564. Therefore, PK‐guided dosing emerges as the dominant strategy offering both better health outcomes and lower costs. The variables that had the greatest impact on the overall ICER were the adverse event rates in the BSA and PK groups, model time horizon, utility of progression‐free survival and PREDICT assay cost. Our univariate and multivariate sensitivity analysis confirmed that the ICER for PK FOLFOX consistently remained below $50 000 per QALY across all tested variables.ConclusionsPK dose management of 5‐FU‐based chemotherapy in mCRC patients appears to be a cost‐saving strategy in Australia. However, our model estimates are drawn from limited, low‐quality evidence. Further evidence from randomized controlled trials (RCTs), directly comparing PK‐based to BSA‐based dosing across a variety of current regimens, is needed to address our model's uncertainties.

Funder

Cancer Council NSW

Publisher

Wiley

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