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

Francesco Di Costanzo, Roberto Ravasio, Alberto Sobrero, Oscar Bertetto, Orazio Vinante, Gabriele Luppi, Roberto Labianca, Dino Amadori, Carlo Barone, Marco Carlo Merlano, Flavia Longo, Giovanni Mansueto, Lorenzo Antonuzzo, Silvia Gasperoni

Research output: Contribution to journalArticle

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 languageEnglish
Pages (from-to)645-655
Number of pages11
JournalClinical Drug Investigation
Volume28
Issue number10
DOIs
Publication statusPublished - 2008

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Leucovorin
National Health Programs
Adjuvant Chemotherapy
Fluorouracil
Colonic Neoplasms
Cost-Benefit Analysis
Costs and Cost Analysis
Capecitabine
Therapeutics
Hospital Emergency Service
Health Transition
Drug Costs
Cost Savings
Ambulatory Care
Health Care Costs
Colorectal Neoplasms
Hospitalization

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 journalArticle

Di Costanzo, F, Ravasio, R, Sobrero, A, Bertetto, O, Vinante, O, Luppi, G, Labianca, R, Amadori, D, Barone, C, Merlano, MC, Longo, F, Mansueto, G, Antonuzzo, L & Gasperoni, S 2008, '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', Clinical Drug Investigation, vol. 28, no. 10, pp. 645-655. https://doi.org/10.2165/00044011-200828100-00005
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. / 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. In: Clinical Drug Investigation. 2008 ; Vol. 28, No. 10. pp. 645-655.
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abstract = "Background and objective: In the recent X-ACT (Xeloda in Adjuvant Colon cancer Therapy) trial, oral capecitabine (Xeloda{\circledR}) 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.",
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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.

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KW - Capecitabine, therapeutic use

KW - Colon cancer

KW - Cost effectiveness

KW - Fluorouracil, therapeutic use

KW - Folinic acid, therapeutic use

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