• Martin Goerner and Petra Riemer-Hommel.
• Department of Hematology, Oncology & Palliative Care, Community Hospital Bielefeld, Germany. martin.goerner@sk-bielefeld.de
• Onkologie. 2009 Nov 1; 32 (11): 647-52.

BackgroundAdjuvant treatment of stage III colon cancer represents a significant economic burden for the German health care system. The available chemotherapy regimens have significantly different medical and economic profiles.MethodsA modeling study based on published clinical trials was performed to assess costs of 5 different regimens (Mayo Clinic, LV5FU2, FOLFOX-4, Xelox, Capecitabine) from the perspective of the statutory sickness funds. Costs were calculated based on the assumption that patients were treated exactly according to a standardized clinical pathway.ResultsTotal costs are highest for FOLFOX-4 (H22,034/patient) and Xelox (H21,411). Lowest costs of the oxaliplatin-free treatments are associated with capecitabine (H4,935), followed by the Mayo Clinic (H6,426) and LV5FU2 protocols (H8,336). The main driver of costs in all instances is drug acquisition (90% of total costs), whereas costs of diagnostics or complications have no major impact (0.5-2%).ConclusionsIn Germany, FOLFOX-4 is the most effective but also the most expensive treatment and represents the current standard. Xelox emerges as a slightly less costly alternative when oral treatment is preferred. For patients not able to tolerate oxaliplatin-based therapy, capecitabine has the best economic profile of all alternative regimens. Drug acquisition costs are by far the most important factor driving costs in all regimens.

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