Cost differential among systemic therapies for colon cancer.

Abstract

583 Background: The National Comprehensive Cancer Network (NCCN) has outlined recommendations for the treatment of various cancers that incorporates alternative chemotherapeutic strategies presumed to be of similar effectiveness. We hypothesized that there is a significant cost-differential between the therapeutically equivalent systemic therapy regimens for colon cancer. Methods: Details of chemotherapy regimens outlined in NCCN guidelines (2013) were acquired for colon cancer. Costs (US$) were calculated based on the payment allowance for Medicare part-B drugs database (2013). Dosage amounts were calculated for an average American patient and additional costs (treatment time, pumps) were added to determine total treatment costs for 6 months. Results: Total of 25 regimens were studied. The median cost for systemic treatment of metastatic colon cancer for a 6-month period was $34,840 (IQR $9,420-$68,840, n=20). The median cost for adjuvant treatment alone was $13,870 (range $2,600-$33,230, n=5). The cost-differential for a single patient between FOLFOX and Folfiri+ziv-aflibercept was $4.2 million for metastatic colon cancer. The addition of novel antineoplastics dramatically increased the price of chemotherapy (Table). Conclusions: Economically significant cost differential exist between chemotherapeutic regimens prescribed as equally effective. Hierarchical adoption of regimens based on therapeutic benefit, cost and patient-specific toxicity profile may help reduce health care costs. [Table: see text]