Modeling Personalized Adjuvant TreaTment in EaRly stage coloN cancer (PATTERN)

Jongeneel, Gabrielle; Greuter, Marjolein J.E.; Erning, Felice N. van; Koopman, Miriam; Medema, Jan Paul; Kandimalla, Raju; Goel, Ajay; Bujanda, Luís; Meijer, Gerrit A.; Fijneman, Remond J.A.; Oijen, Martijn G.H. van; IJzermans, Jan N.M.; Punt, Cornelis J.A.; Vink, Geraldine R.; Coupé, Veerle M.H.

doi:10.1007/s10198-020-01199-4

Cited by 6 publications

(21 citation statements)

References 42 publications

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“…This study evaluated the cost effectiveness of a 3-month adjuvant chemotherapy regimen compared with a 6-month chemotherapy regimen consisting of either FOLFOX or CAPOX in high-risk stage II colon cancer patients using the PATTERN model. 16 For both CAPOX and FOLFOX, the 3-month strategy was less costly compared with the 6-month strategy (cost difference €3612 and €2745 per person, respectively). The lower costs were mainly caused by cost savings related to adjuvant chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Model-based evaluation of the cost effectiveness of 3 versus 6 months’ adjuvant chemotherapy in high-risk stage II colon cancer patients

Jongeneel

Greuter²,

Erning

et al. 2020

Therap Adv Gastroenterol

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Background: Our aim was to evaluate the cost effectiveness of 3 months’ adjuvant chemotherapy versus 6 months in high-risk (T4 stage + microsatellite stable) stage II colon cancer (CC) patients. Methods: Using the validated PATTERN Markov cohort model, which simulates the disease progression of stage II CC patients from diagnosis to death, we first evaluated a reference strategy in which high-risk patients were treated with chemotherapy for 6 months. In the second strategy, treatment duration was shortened to 3 months. Both strategies were evaluated for CAPOX (capecitabine plus oxaliplatin) and FOLFOX (fluorouracil, leucovorin and oxaliplatin). Based on trial data, we assumed that shortened treatment duration compared with a 6-month regimen was equally effective for CAPOX and less effective for FOLFOX. Adverse events were highest in the 6-month strategy. Analyses were conducted from a societal perspective using a lifelong time horizon. Outcomes were number of CC deaths per 1000 patients and total discounted costs and quality-adjusted life-years (QALYs) per patient (pp). Incremental net monetary benefit (iNMB) was calculated using a willingness-to-pay value of €50,000/QALY. Results: For CAPOX, the 6-month strategy resulted in 316 CC deaths per 1000 patients, 6.71 QALYs pp and total costs of €41,257 pp. The 3-month strategy resulted in an equal number of CC deaths, but higher QALYs (6.80 pp) and lower costs (€37,645 pp), leading to a iNMB of €8454 per person for 3 months versus 6 months. For FOLFOX, the 6-month strategy resulted in 316 CC deaths per 1000 patients, 6.71 QALYs pp and total costs of €47,135 pp. The 3-month strategy resulted in more CC deaths (393), lower QALYs (6.19 pp) and lower costs (€44,389 pp). An iNMB of −€23,189 was found for 3 months versus 6 months. Conclusion: Our findings indicate that 3 months’ adjuvant chemotherapy should be considered as standard of care in high-risk stage II CC patients for CAPOX, but not for FOLFOX.

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Section: Discussionmentioning

confidence: 99%

Model-based evaluation of the cost effectiveness of 3 versus 6 months’ adjuvant chemotherapy in high-risk stage II colon cancer patients

Jongeneel

Greuter²,

Erning

et al. 2020

Therap Adv Gastroenterol

Self Cite

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“…The PATTERN model has been extensively described elsewhere. 12 A flowchart of the model is shown in Figure 1 and model parameters are shown in Appendix 1 . In brief, the PATTERN model is a Markov cohort model with a lifelong time horizon and a 1-month cycle length.…”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, the model was externally validated and updated if necessary using the 2015 NCR data. 12 …”

Section: Methodsmentioning

confidence: 99%

“… d Proportions apply across the entire 3-month treatment regimen. e To calculate the absenteeism costs we assumed that; (1) the female to male ratio was 0.53/0.47, 12 (2) number of hours worked per week was 28 and 25 for women and 40 and 38 for men in the age groups <55 and 55–65, respectively, 32 and (3) patients do not work during chemotherapy. CAP, capecitabine monotherapy; CAPOX, regimen that includes the drugs capecitabine and oxaliplatin; FOLFOX, regimen that includes the drugs leucovorin, fluoropyrimidine and oxaliplatin.…”

Section: Methodsmentioning

confidence: 99%

“…For these analyses, we used the Personalized Adjuvant TreaTment in EaRly stage coloN cancer (PATTERN) model. 12 …”

Section: Introductionmentioning

confidence: 99%

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Model-based effectiveness and cost-effectiveness of risk-based selection strategies for adjuvant chemotherapy in Dutch stage II colon cancer patients

Jongeneel

Greuter

Erning

et al. 2021

Therap Adv Gastroenterol

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Background: We aimed to evaluate the cost-effectiveness of risk-based strategies to improve the selection of surgically treated stage II colon cancer (CC) patients for adjuvant chemotherapy. Methods: Using the ‘Personalized Adjuvant TreaTment in EaRly stage coloN cancer’ (PATTERN) model, we evaluated five selection strategies: (1) no chemotherapy, (2) Dutch guideline recommendations assuming observed adherence, (3) Dutch guideline recommendations assuming perfect adherence, (4) biomarker mutation OR pT4 stage strategy in which patients with MSS status combined with a pT4 stage or a mutation in BRAF and/or KRAS receive chemotherapy assuming perfect adherence and (5) biomarker mutation AND pT4 stage strategy in which patients with MSS status combined with a pT4 stage tumor and a BRAF and/or KRAS mutation receive chemotherapy assuming perfect adherence. Outcomes were number of CC deaths per 1000 patients and total discounted costs and quality-adjusted life-years (QALYs) per patient (pp). Analyses were conducted from a societal perspective. The robustness of model predictions was assessed in sensitivity analyses. Results: The reference strategy, that is, no adjuvant chemotherapy, resulted in 139 CC deaths in a cohort of 1000 patients, 8.077 QALYs pp and total costs of €22,032 pp. Strategies 2–5 were more effective (range 8.094–8.217 QALYs pp and range 118–136 CC deaths per 1000 patients) and more costly (range €22,404–€25,102 pp). Given a threshold of €50,000/QALY, the optimal use of resources would be to treat patients with either the full adherence strategy and biomarker mutation OR pT4 stage strategy. Conclusion: Selection of stage II CC patients for chemotherapy can be improved by either including biomarker status in the selection strategy or by improving adherence to the Dutch guideline recommendations.

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Cost‐effectiveness of adjuvant chemotherapy for high‐risk stage II and stage III colon cancer in South Africa

et al. 2023

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BackgroundColon cancer incidence is rising in low‐ and middle‐income countries (LMICs), where resource limitations and cost often dictate treatment decisions. In this study, we evaluate the cost‐effectiveness of adjuvant chemotherapy for high‐risk stage II and stage III colon cancer treatment in South Africa (ZA) and illustrate how such analyses can inform cancer treatment recommendations in a LMIC.MethodsWe created a decision‐analytic Markov model to compare lifetime costs and outcomes for patients with high‐risk stage II and stage III colon cancer treated with three adjuvant chemotherapy regimens in a public hospital in ZA: capecitabine and oxaliplatin (CAPOX) for 3 and 6 months, and capecitabine for 6 months, compared to no adjuvant treatment. The primary outcome was the incremental cost‐effectiveness ratio (ICER) in international dollars (I$) per disability‐adjusted life‐year (DALY) averted, at a willingness‐to‐pay (WTP) threshold equal to the 2021 ZA gross domestic product per capita (I$13,764/DALY averted).ResultsCAPOX for 3 months was cost‐effective for both patients with high‐risk stage II and patients with stage III colon cancer (ICER = I$250/DALY averted and I$1042/DALY averted, respectively), compared to no adjuvant chemotherapy. In subgroup analyses of patients by tumor stage and number of positive lymph nodes, for patients with high‐risk stage II colon cancer and T4 tumors, and patients with stage III colon cancer with T4 or N2 disease. CAPOX for 6 months was cost‐effective and the optimal strategy. The optimal strategy in other settings will vary by local WTP thresholds. Decision analytic tools can be used to identify cost‐effective cancer treatment strategies in resource‐constrained settings.ConclusionColon cancer incidence is increasing in low‐ and middle‐income countries, including South Africa, where resource constraints can impact treatment decisions. This cost‐effectiveness study evaluates three systemic adjuvant chemotherapy options, compared to surgery alone, for patients in South African public hospitals after surgical resection for high‐risk stage II and stage III colon cancer. Doublet adjuvant chemotherapy (capecitabine and oxaliplatin) for 3 months is the cost‐effective strategy and should be recommended in South Africa.

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Modeling Personalized Adjuvant TreaTment in EaRly stage coloN cancer (PATTERN)

Cited by 6 publications

References 42 publications

Model-based evaluation of the cost effectiveness of 3 versus 6 months’ adjuvant chemotherapy in high-risk stage II colon cancer patients

Model-based evaluation of the cost effectiveness of 3 versus 6 months’ adjuvant chemotherapy in high-risk stage II colon cancer patients

Model-based effectiveness and cost-effectiveness of risk-based selection strategies for adjuvant chemotherapy in Dutch stage II colon cancer patients

Cost‐effectiveness of adjuvant chemotherapy for high‐risk stage II and stage III colon cancer in South Africa

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