Cost-effectiveness analysis of irinotecan plus fluorouracil/folinic acid compared with fluorouracil/folinic acid alone as first-line treatment for advanced colorectal cancer

An economic evaluation was conducted to test whether irinotecan in combination with fluorouracil and folinic acid was as cost-effective (within the Spanish Health Service) as fluorouracil and folinic acid alone in the first-line treatment of advanced colorectal cancer. Efficacy data from the study by Douillard et al were used. Data on resource use for the two groups of patients were collected for 41 Spanish patients and the assigned costs were from various Spanish sources. The incremental cost-effectiveness ratios of the alternatives were calculated by comparing costs in relation to survival. Douillard's trial showed an improved median survival of 2.80 months (0.233 years) in patients in the irinotecan group compared to the control group. Cumulative drug costs and other resource consumption per patient (e.g. average number of cycles per treatment) were higher in the irinotecan group. Patients in the control group required greater additional chemotherapy following the trial period. The average cost per patient was ©22,280 and ©14,016 in the irinotecan and control groups, respectively. The incremental cost per life-year gained in the basic case was ©35,416. The results indicate that the combination of irinotecan with fluorouracil and folinic acid can be considered cost-effective as first-line treatment of advanced colorectal cancer in the Spanish setting.