ADJUVANT THERAPY FOR STAGE-III COLON-CANCER - ECONOMICS RETURNS TO RESEARCH AND COST-EFFECTIVENESS OF TREATMENT

Background: In 1989, the National Cancer Institute issued a clinical announcement advising physicians of the benefits of combined levamisole and fluorouracil as an adjuvant treatment for patients with stage III colon cancer. Purpose: We have estimated the cost-effectiveness of the combined treatment and estimated the social return on the National Institutes of Health (NIH) research investment that led to this innovative cancer treatment. Methods: A computer simulation model, CAN*TROL, was used to estimate costs and benefits for a population cross-section receiving the adjuvant treatment. A method similar to ''Q-TWiST'' was used to assess the impact of quality-of-life adjustments. Results: For a typical base-line case, the calculated cost-effectiveness is a very favorable $2094 per year of life saved. Using a variety of less favorable assumptions, cost-effectiveness is still less than $5000 per year of life saved, again a favorable value. Quality-of-life adjustments have a negligible effect on the cost-effectiveness outcome. The net present value of the return to the NIH research investment is estimated to be $1.66 billion. Conclusions: Under a wide range of reasonable assumptions, adjuvant therapy for stage III colon cancer appears to be a very cost-effective procedure. The investment in the research that resulted in this therapy promises to yield a high return.