Modified FLOX as first-line chemotherapy for metastatic colorectal cancer patients in the public health system in Brazil: Effectiveness and cost-utility analysis

Nebuloni,Daniela  R.; Mak,Milena  P.; Souza,Fabiano   Hahn; Saragiotto,Daniel  F.; Júlio,Thiago; De Castro Jr,Gilberto; Sabbaga,Jorge; Hoff,Paulo  M.

doi:10.3892/mco.2012.12

January-February 2013 Volume 1 Issue 1

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January-February 2013 Volume 1 Issue 1

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Article

Modified FLOX as first-line chemotherapy for metastatic colorectal cancer patients in the public health system in Brazil: Effectiveness and cost-utility analysis

Authors:
- Daniela R. Nebuloni
- Milena P. Mak
- Fabiano Hahn Souza
- Daniel F. Saragiotto
- Thiago Júlio
- Gilberto De Castro Jr
- Jorge Sabbaga
- Paulo M. Hoff
View Affiliations / Copyright

Affiliations: Clinical Oncology Department, Cancer Institute of the State of Sao Paulo (ICESP), CEP 01246-000, Sao Paulo, SP, Brazil , Clinical Oncology Department, University of Sao Paulo Medical School, CEP 01246-903, Sao Paulo, SP, Brazil , Oncology Center, Sírio-Libanês Hospital, CEP 01308-050, Sao Paulo, SP, Brazil
Pages: 175-179
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Published online on: August 20, 2012

https://doi.org/10.3892/mco.2012.12
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Abstract

Incorporation of new drugs for treatment of metastatic colorectal cancer (mCRC) has led to a clear improvement in overall patient survival, the added cost of treatment, however, is a major concern worldwide. The cost-effectiveness of using a modified FLOX (mFLOX) regimen for treating mCRC patients was delineated. In this study, 82 consecutive mCRC patients were treated with leucovorin (LV) at 20 mg/m2 in combination with weekly bolus of 5-fluorouracil (5-FU) (500 mg/m2) for 6 consecutive weeks and oxaliplatin (85 mg/m2) at weeks 1, 3 and 5, every 8 weeks. Overall survival (OS) and toxicity were evaluated. A Markov Model with a 2-year time horizon and 2-week cycles was developed, comparing mFLOX and mFOLFOX6 in a Brazilian environment. Health outcomes were measured in quality-ajusted life years (QALYs). The median overall period of survival was 19 months, while the estimated 1-year survival was 75%. Response by RECIST was assessed in 33 patients. Partial response was observed in 39.4% of patients, while 36.3% were stable. The mFLOX regimen cost was BRL 9,000, while the mFOLFOX6 BRL 22,000 (1 EUR=2.29 BRL), leading to an incremental costed of BRL 13,000, considering a 20-week period of first‑line therapy. The incremental effect of the mFOLFOX was of 0,117 QALY. The incremental cost-effectiveness ratio of mFOLFOX6 was of BRL 110,344/QALY. The sensitivity analysis detected no differences in the outcome measures. In conclusion, the mFLOX is an active regimen in mCRC patients, possibly providing a cost-effective option in public health systems.

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Journals

International Journal of Molecular Medicine

International Journal of Oncology

Molecular Medicine Reports

Oncology Reports

Experimental and Therapeutic Medicine

Oncology Letters

Biomedical Reports

Molecular and Clinical Oncology

World Academy of Sciences Journal

International Journal of Functional Nutrition

International Journal of Epigenetics

Medicine International

Modified FLOX as first-line chemotherapy for metastatic colorectal cancer patients in the public health system in Brazil: Effectiveness and cost-utility analysis

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