SCOT: a comparison of cost-effectiveness from a large randomised phase III trial of two durations of adjuvant Oxaliplatin combination chemotherapy for colorectal cancer

Robles-Zurita, José, Boyd, Kathleen A., Briggs, Andrew H., Iveson, Timothy, Kerr, Rachel S., Saunders, Mark P., Cassidy, Jim, Hollander, Niels Henrik, Tabernero, Josep, Segelov, Eva, Glimelius, Bengt, Harkin, Andrea, Allan, Karen, McQueen, John, Pearson, Sarah, Waterston, Ashita, Medley, Louise, Wilson, Charles, Ellis, Richard, Essapen, Sharadah, Dhadda, Amandeep S., Hughes, Rob, Falk, Stephen, Raouf, Sherif, Rees, Charlotte, Olesen, Rene K., Propper, David, Bridgewater, John, Azzabi, Ashraf, Farrugia, David, Webb, Andrew, Cunningham, David, Hickish, Tamas, Weaver, Andrew, Gollins, Simon, Wasan, Harpreet S. and Paul, James (2018) SCOT: a comparison of cost-effectiveness from a large randomised phase III trial of two durations of adjuvant Oxaliplatin combination chemotherapy for colorectal cancer. British Journal of Cancer, 119 (11), 1332-1338. (doi:10.1038/s41416-018-0319-z).

Abstract

BACKGROUND: The Short Course Oncology Therapy (SCOT) study is an international, multicentre, non-inferiority randomised controlled trial assessing the efficacy, toxicity, and cost-effectiveness of 3 months (3 M) versus the usually given 6 months (6 M) of adjuvant chemotherapy in colorectal cancer. 

METHODS: In total, 6088 patients with fully resected high-risk stage II or stage III colorectal cancer were randomised and followed up for 3–8 years. The within-trial cost-effectiveness analysis from a UK health-care perspective is presented using the resource use data, quality of life (EQ-5D-3L), time on treatment (ToT), disease-free survival after treatment (DFS) and overall survival (OS) data. Quality-adjusted partitioned survival analysis and Kaplan–Meier Sample Average Estimator estimated QALYs and costs. Probabilistic sensitivity and subgroup analysis was undertaken. 

RESULTS: The 3 M arm is less costly (-£4881; 95% CI: -£6269; -£3492) and entails (non-significant) QALY gains (0.08; 95% CI: −0.086; 0.230) due to a better significant quality of life. The net monetary benefit was significantly higher in 3 M under a wide range of monetary values of a QALY. The subgroup analysis found similar results for patients in the CAPOX regimen. However, for the FOLFOX regimen, 3 M had lower QALYs than 6 M (not statistically significant). 

CONCLUSIONS: Overall, 3 M dominates 6 M with no significant detrimental impact on QALYs. The results provide the economic case that a 3 M treatment strategy should be considered a new standard of care.

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Contributors

Author: Timothy Iveson

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