Objectives: Administration of mFOLFOX or CAPOX as adjuvant chemotherapy after tumor resection in patients with stage 3 colon cancer is recommended by National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology to improve survival. We aimed to assess the cost-effectiveness of CAPOX versus mFOLFOX in patients with stage 3 colon cancer.

Methods: A decision tree has been developed with 3 terminal nodes: progression-free, relapsed, death. The expected life years were extracted from a randomized phase 3 trial. Direct medical costs for the two treatments, administration, adverse events, and other costs were based on data from real-world studies. All costs were in (Euro €), and cost has been adjusted by 3% annual inflation rate. The incremental cost-effectiveness ratio (ICER) and incremental net benefit (INB) of CAPOX vs. mFOLFOX from a payer’s perspective based on willingness to pay (WTP) of 60,000 € were calculated. In addition, sensitivity analysis was done based on WTP of 10,000-100,000 € and minimum-maximum expected cost of each regimen to assess the robustness of the results.

Results: CAPOX, compared to mFOLFOX, was cost effective ; resulting in an incremental net benefit (INB) of 101,146 € and the results were robust as indicated by our sensitivity analysis. The administration cost of mFOLFOX has the highest impact on the cost-effectiveness results as it requires Intravenous (IV) access and more hospital visits compared to CAPOX in which capecitabine is given orally.

Conclusion: Based on our calculation in this study, CAPOX is a cost-effective adjuvant option compared with mFOLFOX in patient with stage 3 colon cancer.