“Optimizing Adjuvant Treatment for Stage II Colon Cancer: A Biomarker-based Cost- effectiveness Analysis

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Adjuvant chemotherapy is not recommended for patients with average-risk stage II colon cancer. Patients lacking CDX2 biomarker expression (CDX2-) face a higher rate of developing recurrence compared to CDX2+ patients. Adjuvant chemotherapy only benefits CDX2- patients. We determined the optimal adjuvant treatment for different test-and-treat strategies in average-risk stage II colon cancer patients using a dynamic decision model. Testing for the absence of CDX2 expression followed by adjuvant chemotherapy for those without biomarker expression is cost-saving under a range of assumptions and a wide range of parameter values tested on sensitivity analyses for cost of the test, prevalence of CDX2- patients and effectiveness of adjuvant chemotherapy. Identifying a small subgroup of average risk stage II colon cancer CDX2- patients for targeted chemotherapy is effective and cost saving.