Cost-effectiveness Analysis of Fluorouracil, Leucovorin, and Irinotecan versus Epirubicin, Cisplatin, and Capecitabine in Patients with Advanced Gastric Adenocarcinoma.

Feng Wen,Xiaoxi Zeng,Qiu Li,Hanrui Zheng,Yifan Wu,John Wheeler,Ping Fu

doi:10.1038/srep36060

Feng Wen, Xiaoxi Zeng + Show 5 more

Open Access

https://doi.org/10.1038/srep36060

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Abstract

No standard treatment has been accepted widely for the first-/second-line therapy for advanced gastric cancer (AGC). The current study aimed to determine a preferred strategy between FOLFIRI (fluorouracil, leucovorin, and irinotecan) and ECX (epirubicin, cisplatin,and capecitabine) for AGC from the cost-effectiveness perspective. According to a French intergroup study, two groups (ECX arm and FOLFIRI arm) and three health states (progression-free survival (PFS), progressive disease (PD) and death) were analyzed in the current Markov model. All the medical costs were calculated from a Chinese societal perspective. Although FOLFIRI was an acceptable first-line therapy in the treatment of AGC with a better time-to treatment failure (TTF) compared to ECX, ECX arm (ECX followed by FOLFIRI) gained 0.08 quality-adjusted life months (QALMs) more effectiveness benefit compared with FOLFIRI arm (FOLFIRI followed by ECX). Additionally, a lower cost was found in ECX arm ($23,813.13 versus $24,983.70). Hence, the strategy of FOLFIRI arm is dominated by ECX arm ($4,125.8 per QALM in FOLIRI arm; $3,879.724 per QALM in ECX arm). ECX followed by FOLFIRI was a preferred strategy with more effectiveness and lower cost compared with FOLFIRI followed by ECX for the treatment of AGC.

Highlights

No standard treatment has been accepted widely for the first-/second-line therapy for advanced gastric cancer (AGC)
FOLFIRI was an acceptable first-line therapy in the treatment of AGC with a better time-to treatment failure (TTF) compared to ECX, ECX arm (ECX followed by FOLFIRI) gained 0.08 quality-adjusted life months (QALMs) more effectiveness benefit compared with FOLFIRI arm (FOLFIRI followed by ECX)
Since FOLFIRI regimen cost much more than ECX regimen ($2,275.46 versus $959.68), cost for progression-free survival (PFS) state was higher in FOLFIRI arm than in ECX arm ($18,481.71 versus $8,499.92)

Summary

Introduction

No standard treatment has been accepted widely for the first-/second-line therapy for advanced gastric cancer (AGC). The current study aimed to determine a preferred strategy between FOLFIRI (fluorouracil, leucovorin, and irinotecan) and ECX (epirubicin, cisplatin,and capecitabine) for AGC from the cost-effectiveness perspective. No standard chemotherapy regimens have been widely accepted as the first-line or second-line treatment in clinical practice[4]. FOLFIRI is recommended as an acceptable combination in the first-line treatment of AGC by national comprehensive cancer network (NCCN) clinical practice guidelines. It is regarded as a promising backbone for the target therapy, the medical burden would be increased dramatically with the combination of chemotherapy and target agents. It is of great importance to make a preferred decision for AGC patients in the first-line and second-line treatments

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