ECONOMIC EVALUATION OF FOLFOX-BASED TOTAL NEOADJUVANT THERAPY FOR LOCALLY ADVANCED RECTAL CANCER IN INDIA
Author(s)
Shruthi Ashok Kumar, PharmD1, Norah Elsa Shynu, Pharm D2, Anna Ankita, PharmD3, Arathi Viswam, PharmD3, Adusumilli Pramod Kumar, PhD3.
1Student, M S Ramaiah University Of Applied Sciences, Bengaluru, India, 2M S Ramaiah University Of Applied Sciences, Bengaluru, India, 3M S Ramaiah University Of Applied Sciences, Bangalore, India.
1Student, M S Ramaiah University Of Applied Sciences, Bengaluru, India, 2M S Ramaiah University Of Applied Sciences, Bengaluru, India, 3M S Ramaiah University Of Applied Sciences, Bangalore, India.
OBJECTIVES: This study aimed to evaluate the cost-utility of FOLFOX-based total neoadjuvant therapy (TNT) compared with long-course chemoradiotherapy (LCCRT) for the treatment of locally advanced rectal cancer in India. Lifetime costs and quality-adjusted life years (QALYs) associated with each treatment strategy were estimated using a Markov model. The robustness of the findings was assessed through probabilistic sensitivity analysis from the Indian payer perspective.
METHODS: A cohort-based Markov model was developed to simulate disease progression in patients with locally advanced rectal cancer over a 20-year time horizon with monthly cycles. Two treatment strategies were compared: FOLFOX-based TNT, comprising induction chemotherapy followed by radiotherapy and surgery, and standard LCCRT followed by surgery. Transition probabilities were derived from real-world evidence, while costs and utility values were obtained from published literature and adapted to the Indian healthcare setting. Costs were discounted at an annual rate of 3%. Model outcomes included total costs, QALYs, and incremental cost-effectiveness. Uncertainty was assessed through probabilistic sensitivity analysis using Monte Carlo simulation at a willingness-to-pay threshold of INR 1,50,000 (€1,600) per QALY.
RESULTS: Over the 20-year time horizon, TNT generated 7.28 QALYs at a total cost of INR 10,17,304 (€10,900), whereas LCCRT generated 6.87 QALYs at a total cost of INR 10,80,151 (€11,600). Compared with LCCRT, TNT resulted in an incremental gain of 0.41 QALYs while reducing costs by INR 62,847 (€700), demonstrating dominance. Probabilistic sensitivity analysis indicated that TNT was cost-effective in 75% of simulations at the specified willingness-to-pay threshold.
CONCLUSIONS: FOLFOX-based total neoadjuvant therapy was associated with improved health outcomes and lower overall costs compared with long-course chemoradiotherapy for patients with locally advanced rectal cancer in India. As a dominant strategy, TNT provides greater value by delivering additional QALYs while reducing healthcare expenditure. These findings support the adoption of TNT as a cost-effective neoadjuvant treatment approach in resource-constrained healthcare settings.
METHODS: A cohort-based Markov model was developed to simulate disease progression in patients with locally advanced rectal cancer over a 20-year time horizon with monthly cycles. Two treatment strategies were compared: FOLFOX-based TNT, comprising induction chemotherapy followed by radiotherapy and surgery, and standard LCCRT followed by surgery. Transition probabilities were derived from real-world evidence, while costs and utility values were obtained from published literature and adapted to the Indian healthcare setting. Costs were discounted at an annual rate of 3%. Model outcomes included total costs, QALYs, and incremental cost-effectiveness. Uncertainty was assessed through probabilistic sensitivity analysis using Monte Carlo simulation at a willingness-to-pay threshold of INR 1,50,000 (€1,600) per QALY.
RESULTS: Over the 20-year time horizon, TNT generated 7.28 QALYs at a total cost of INR 10,17,304 (€10,900), whereas LCCRT generated 6.87 QALYs at a total cost of INR 10,80,151 (€11,600). Compared with LCCRT, TNT resulted in an incremental gain of 0.41 QALYs while reducing costs by INR 62,847 (€700), demonstrating dominance. Probabilistic sensitivity analysis indicated that TNT was cost-effective in 75% of simulations at the specified willingness-to-pay threshold.
CONCLUSIONS: FOLFOX-based total neoadjuvant therapy was associated with improved health outcomes and lower overall costs compared with long-course chemoradiotherapy for patients with locally advanced rectal cancer in India. As a dominant strategy, TNT provides greater value by delivering additional QALYs while reducing healthcare expenditure. These findings support the adoption of TNT as a cost-effective neoadjuvant treatment approach in resource-constrained healthcare settings.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE238
Topic
Economic Evaluation, Health Policy & Regulatory, Health Technology Assessment
Disease
Oncology, Urinary/Kidney Disorders