Adjuvant chemotherapy for colon cancer--analysis of treatment costs from the perspective of statutory sickness funds.

OBJECTIVE: The aim of this study was to calculate sickness funds' costs associated with the application of three different adjuvant chemotherapy regimens for patients with stage III colon cancer treated in different settings (inpatient/outpatient) in Germany.
METHODS: Standard procedures according to national guidelines were defined for inpatient and outpatient diagnostics and treatment. Costs associated with the three commonly used standard treatment regimens were calculated from the perspective of statutory sickness funds.
RESULTS: The highest costs are associated with the FOLFOX regimen in the outpatient (21530.00 euro) as well as in the inpatient setting (23170.00 euro). Of the two 5-FU bolus regimens, the monthly MAYO-Clinic protocol (inpatient 7070.00 euro vs. outpatient 6610.00 euro) is significantly less expensive than the weekly NSABP protocol (17569.00 euro vs. 12200.00 euro). Costs are remarkably lower in the outpatient setting as compared to inpatient application of the MAYO-Clinic protocol or the FOLFOX regimen. In the outpatient setting, medication costs are the major cost-driving factor, comprising 82% of the total costs of the MAYO-Clinic protocol, 94% of the total costs of the NSABP, and 91% of the total costs of FOLFOX-4 regimen. In the inpatient setting, costs for medications are less important with regard to total costs (10% MAYO-Clinic, 7% NSABP, 10% FOLFOX-4), whereas costs for staff and hotel-like services become more important.
CONCLUSION: From a health insurance perspective, substantial cost savings may be realised through the use of established chemotherapy regimens, if most patients are treated in the outpatient setting. In the outpatient setting, costs for drug prices are the main cost driver, so further savings could be realised for third-party payers if prices of chemotherapeutic drugs are reduced. For economic reasons, patients who are candidates for bolus 5-FU regimens, should not be treated according to the NSABP protocol. The MAYO-Clinic protocol is a low cost regimen in both settings, but for medical reasons alternative therapies such as capecitabine or infusional 5 FU protocols must be preferred in patients unable to tolerate the new standard FOLFOX-4.