Abstract
Background and objective: In the recent X-ACT (Xeloda in Adjuvant Colon cancer Therapy) trial, oral capecitabine (Xeloda®) demonstrated superior efficacy and an improved safety profile compared with infused fluorouracil + leucovorin (folinic acid) [FU+LV] in patients with Dukes' C colorectal cancer. We used the X-ACT results to determine the cost effectiveness of capecitabine compared with FU+LV from the perspective of the Italian National Health Service (NHS). Methods: Medical resource use data were collected throughout the treatment period. Unit costs for drug administration, hospitalization, emergency room visits and concomitant medications were obtained using Italian published sources. A health-state transition model was used to estimate the incremental cost-effectiveness ratio per quality-adjusted life-month (QALM) gains in the intent-to-treat population (1004 and 983 patients in the capecitabine and FU+LV arms, respectively). Costs and effectiveness were discounted at 3.5%. Costs were calculated in €s (2005 values). Results: Administration of capecitabine required fewer clinic visits per patient than FU+LV (7.35 vs 28.0, respectively). Mean acquisition costs per patient for capecitabine were higher than for FU+LV (€2533 vs €231, respectively), but this difference was offset by the difference in mean chemotherapy administration costs per patient for FU+LV (€4338, compared with €152 for capecitabine). Mean total hospital days and medication costs for treatment-related adverse events were higher for FU+LV than for capecitabine (€352 vs €78, respectively). The cost of emergency room visits for the treatment of adverse events did not differ between the treatment groups. With respect to the lifetime horizon, compared with FU+LV, capecitabine is projected to increase QALMs by a mean 6.5 months, with overall cost savings of €2234 over the treatment period. These findings show that capecitabine is an economically dominant treatment in this setting. Conclusions: Adjuvant capecitabine for patients with Dukes' C colon cancer has the same activity in terms of outcome when compared with FU+LV but is a lower cost option from the economic perspective of the Italian NHS.
| Original language | English |
|---|---|
| Pages (from-to) | 645-655 |
| Number of pages | 11 |
| Journal | Clinical Drug Investigation |
| Volume | 28 |
| Issue number | 10 |
| DOIs | |
| Publication status | Published - 2008 |
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Keywords
- Capecitabine, therapeutic use
- Colon cancer
- Cost effectiveness
- Fluorouracil, therapeutic use
- Folinic acid, therapeutic use
ASJC Scopus subject areas
- Pharmacology (medical)
- Pharmacology
Cite this
Capecitabine versus bolus fluorouracil plus leucovorin (folinic acid) as adjuvant chemotherapy for patients with Dukes' C colon cancer : Economic evaluation in an Italian NHS setting. / Di Costanzo, Francesco; Ravasio, Roberto; Sobrero, Alberto; Bertetto, Oscar; Vinante, Orazio; Luppi, Gabriele; Labianca, Roberto; Amadori, Dino; Barone, Carlo; Merlano, Marco Carlo; Longo, Flavia; Mansueto, Giovanni; Antonuzzo, Lorenzo; Gasperoni, Silvia.
In: Clinical Drug Investigation, Vol. 28, No. 10, 2008, p. 645-655.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Capecitabine versus bolus fluorouracil plus leucovorin (folinic acid) as adjuvant chemotherapy for patients with Dukes' C colon cancer
T2 - Economic evaluation in an Italian NHS setting
AU - Di Costanzo, Francesco
AU - Ravasio, Roberto
AU - Sobrero, Alberto
AU - Bertetto, Oscar
AU - Vinante, Orazio
AU - Luppi, Gabriele
AU - Labianca, Roberto
AU - Amadori, Dino
AU - Barone, Carlo
AU - Merlano, Marco Carlo
AU - Longo, Flavia
AU - Mansueto, Giovanni
AU - Antonuzzo, Lorenzo
AU - Gasperoni, Silvia
PY - 2008
Y1 - 2008
N2 - Background and objective: In the recent X-ACT (Xeloda in Adjuvant Colon cancer Therapy) trial, oral capecitabine (Xeloda®) demonstrated superior efficacy and an improved safety profile compared with infused fluorouracil + leucovorin (folinic acid) [FU+LV] in patients with Dukes' C colorectal cancer. We used the X-ACT results to determine the cost effectiveness of capecitabine compared with FU+LV from the perspective of the Italian National Health Service (NHS). Methods: Medical resource use data were collected throughout the treatment period. Unit costs for drug administration, hospitalization, emergency room visits and concomitant medications were obtained using Italian published sources. A health-state transition model was used to estimate the incremental cost-effectiveness ratio per quality-adjusted life-month (QALM) gains in the intent-to-treat population (1004 and 983 patients in the capecitabine and FU+LV arms, respectively). Costs and effectiveness were discounted at 3.5%. Costs were calculated in €s (2005 values). Results: Administration of capecitabine required fewer clinic visits per patient than FU+LV (7.35 vs 28.0, respectively). Mean acquisition costs per patient for capecitabine were higher than for FU+LV (€2533 vs €231, respectively), but this difference was offset by the difference in mean chemotherapy administration costs per patient for FU+LV (€4338, compared with €152 for capecitabine). Mean total hospital days and medication costs for treatment-related adverse events were higher for FU+LV than for capecitabine (€352 vs €78, respectively). The cost of emergency room visits for the treatment of adverse events did not differ between the treatment groups. With respect to the lifetime horizon, compared with FU+LV, capecitabine is projected to increase QALMs by a mean 6.5 months, with overall cost savings of €2234 over the treatment period. These findings show that capecitabine is an economically dominant treatment in this setting. Conclusions: Adjuvant capecitabine for patients with Dukes' C colon cancer has the same activity in terms of outcome when compared with FU+LV but is a lower cost option from the economic perspective of the Italian NHS.
AB - Background and objective: In the recent X-ACT (Xeloda in Adjuvant Colon cancer Therapy) trial, oral capecitabine (Xeloda®) demonstrated superior efficacy and an improved safety profile compared with infused fluorouracil + leucovorin (folinic acid) [FU+LV] in patients with Dukes' C colorectal cancer. We used the X-ACT results to determine the cost effectiveness of capecitabine compared with FU+LV from the perspective of the Italian National Health Service (NHS). Methods: Medical resource use data were collected throughout the treatment period. Unit costs for drug administration, hospitalization, emergency room visits and concomitant medications were obtained using Italian published sources. A health-state transition model was used to estimate the incremental cost-effectiveness ratio per quality-adjusted life-month (QALM) gains in the intent-to-treat population (1004 and 983 patients in the capecitabine and FU+LV arms, respectively). Costs and effectiveness were discounted at 3.5%. Costs were calculated in €s (2005 values). Results: Administration of capecitabine required fewer clinic visits per patient than FU+LV (7.35 vs 28.0, respectively). Mean acquisition costs per patient for capecitabine were higher than for FU+LV (€2533 vs €231, respectively), but this difference was offset by the difference in mean chemotherapy administration costs per patient for FU+LV (€4338, compared with €152 for capecitabine). Mean total hospital days and medication costs for treatment-related adverse events were higher for FU+LV than for capecitabine (€352 vs €78, respectively). The cost of emergency room visits for the treatment of adverse events did not differ between the treatment groups. With respect to the lifetime horizon, compared with FU+LV, capecitabine is projected to increase QALMs by a mean 6.5 months, with overall cost savings of €2234 over the treatment period. These findings show that capecitabine is an economically dominant treatment in this setting. Conclusions: Adjuvant capecitabine for patients with Dukes' C colon cancer has the same activity in terms of outcome when compared with FU+LV but is a lower cost option from the economic perspective of the Italian NHS.
KW - Capecitabine, therapeutic use
KW - Colon cancer
KW - Cost effectiveness
KW - Fluorouracil, therapeutic use
KW - Folinic acid, therapeutic use
UR - http://www.scopus.com/inward/record.url?scp=51649096852&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=51649096852&partnerID=8YFLogxK
U2 - 10.2165/00044011-200828100-00005
DO - 10.2165/00044011-200828100-00005
M3 - Article
C2 - 18783303
AN - SCOPUS:51649096852
VL - 28
SP - 645
EP - 655
JO - Clinical Drug Investigation
JF - Clinical Drug Investigation
SN - 1173-2563
IS - 10
ER -