Cost of Treatment and Cost of Follow-Up (Year 1 and 2)

Appendix II: cost calculations

Cost of treatment and cost of follow-up (year 1 and 2)

Within the RW observational study, resource use data were drawn from a random subset of 206 individual patients included in this study. Mean costs per patient were calculated for the four most common treatment regimens seen in daily practice: 5-FU/LV, capecitabine, 5-FU/LV with oxaliplatin (FOLFOX) and capecitabine with oxaliplatin (CAPOX). Total costs for individual patients were determined by the identification of resource use and unit costs of the following cost components: inpatient hospital days, intensive care days, outpatient visits, consultations by telephone, daycare treatments, emergency room visits, radiotherapy, surgical procedures, laboratory services, medical imaging services, chemotherapy and concomitant medications.

Resource use was divided into two time periods, a treatment phase (period 1) and a follow- up phase (Period 2). Period 1 began on day 1 of the first administration of adjuvant chemotherapy. To capture resource use resulting from treatment related toxicity, period 1 ended one month after the last administration of chemotherapy. Period 2 started one month after the last administration of chemotherapy and lasted until disease progression (or end of follow up).(1) Cost in the treatment, follow-up phase (period 1 and 2 Euro 2012) FL only FL + oxaliplatin 5FU/LV Capecitabine FOLFOX CAPOX n = 206 N = 15 N = 89 N = 37 N = 65 Total treatment costs mean € 6,163 € 5,229 € 27,446 € 14,783 SD € 3,076 € 3,356 € 11,938 € 5,944 Total costs of follow-up mean € 3,518 € 4,507 € 5,347 € 3,578 SD € 3,863 € 8,083 € 7,511 € 4,240 Share of regimen within RW population 15% 85% 48% 52%

Pooled total treatment costs* mean € 5,369 € 20,861 SD € 3,302 € 8,555 Total costs of follow-up mean € 4,293 SD € 6,677 Average Follow-up time 1.8 year

Average cost of follow-up/ 3-month cycle, during year 1 and 2 mean € 596 SD € 927 * calculated by multiplying costs per regimen by the actual share found in RW practice Resource use & costs year 3 - 5(2)

unit costs units/3 months costs/cycle

Laboratory tests € 38 0.50 € 19 Ultrasound liver € 92 0.25 € 23 X-ray of thorax € 55 0.25 € 14 Colonoscopy € 473 0.08 € 39 Monitoring visits € 104 0.50 € 52

Totals/ 3- month cycle € 147

Total costs post-relapse (including costs in later treatment lines) in patients receiving FL alone, FL + oxaliplatin or FL + irinotecan as first-line treatment (1) FL FL + FL + alone oxaliplatin irinotecan n = 198 n = 92 n = 26 Total cost post-relapse mean € 20,433 € 29,435 € 41,824 SD € 15,592 € 20,681 € 25,883 Total costs post-relapse over all treatments mean € 24,814 SD € 16,967 Mean survival 466 days

Mean cost post-relapse/ 3-month cycle € 4,872

References

(1) van Gils CWM, Redekop WK, de Groot S, Tan SS, Koopman M, Mol L, et al. Pilot outcomes research: costs and effects of oxaliplatin in stage III and metastatic colorectal cancer. 2010; Available at: http://www.cvz.nl/binaries/live/cvzinternet/hst_content/nl/documenten/rubriek+zorgpakket/imta- onderzoek-dure-geneesmiddelen-1207.pdf. (2) Richtlijnen oncologische zorg, www.oncoline.nl.