Pharmacoeconomic analysis of randomized controlled clinical study to evaluate effects of eicosapentaenoic acid enriched oral nutritional supplement along with radio-chemotherapy in patients with colorectal carcinoma: a cost-effectiveness analysis

Objective A randomized clinical study compare effects of pre-operative eicosapentaenoic acid enriched oral nutritional supplement (EPA-ONS) along with 5-weeks radio-chemotherapy to 5-weeks radio-chemotherapy only on survival and quality of life and safety in colorectal cancer patients had been completed and the results were published elsewhere. This study aimed evaluate cost effectiveness of 5-week EPA-ONS usage compared to no nutritional supplement in terms of survival Material and Methods A total 80 colorectal carcinoma patients had been randomized to 5-week radio-chemotherapy (FUFA+EBRT)+EPA-ONS (2 packages per-day) or radio-chemotherapy(FUFA+EBRT) only equally by stratifying age, gender, nutritional status and radiotherapy method. In study time horizon, survival was evaluated by Kaplan Maier estimator and exponential parametric regression model (best fitting model based on AIC-BIC) was used to extrapolate 10-year survival. Since patients' characteristics, treatment modalities and other procedures were reported to be similar among groups, only cost of EPA-ONS was taken into cost-analysis which is prepared from perspective of reimbursement institute in Turkey Results Mean (95% confidence interval) survival time was 81.6 (75.9 - 87.4) and 65.9 (55.2 - 76.6) months in radio-chemotherapy+EPA-ONS and radio-chemotherapy only groups, respectively. Five week EPA-ONS costs 284.00 USD/per patient. Incremental cost effectiveness ratio (ICER) for in study period was 25.14 USD per life-month gained; when 10-year survival model was used ICER was 9.80 USD per life-month gained. Conclusions Survival analysis revealed that preoperative EPA-ONS usage along with radio-chemotherapy prolonged overall survival. EPA-ONS appears to be a cost-effective concomitant treatment of radio-chemotherapy in patient with colorectal carcinoma.