OBJECTIVES

Approximately 20% of colorectal cancer (CRC) patients present with metastatic disease. The 5-year survival rate for stage IV CRC is less than 15%. Although, combination chemotherapy regimens improve quality of life and prolong the survival rate, they require higher cost of treatment. This study aimed to evaluate treatment response and direct medical costs of treatment in metastatic CRC.

METHODS

The stage IV CRC patients who treated in Siriraj Hospital, Mahidol University, Thailand, during 2009-2014 were included. The patients’ medical records were retrospectively reviewed. Demographic data, risk stratification, tumor marker level, treatment regimens, costs, and outcomes including complications, and 3-year survival rate were evaluated. The total and average direct medical costs of treatment were also analyzed and reported in 2018 United State Dollar (USD).

RESULTS

The total of 797 patients were included. The proportions of chemotherapy treatment and supportive care were 447 (68.8%) and 202 (31.2%), respectively. The overall 3-year survival rate was 19.9%. The patients who received chemotherapy had higher 3-year survival rate (26.4% vs. 7.4%, OR 4.47, 95%CI 2.54-7.88, p<0.001). The significant difference in 3-year survival rate was shown among regimens 5-FU/LV (20.0%), capecitabine (29.0%), FOLFOX/XELOX (25.2%), FOLFIRI (10.0%) and targeted therapy (43.4%), (p=0.019). The 3-year direct medical costs of treatment by supportive care, 5-FU/LV, capecitabine, FOLFOX/XELOX, FOLFIRI, and targeted therapy were 15,807, 20,621, 33,919, 53,850, 79,186, and 91,682 USD, respectively.

CONCLUSIONS

Chemotherapy can improve treatment outcomes compared with supportive care alone. Targeted therapy resulted in the highest 3-year survival rate as well as highest total direct medical costs of care. The patients’ preferences, adverse drug events and cost-effectiveness issues related with each treatment regimen should also be concerned.