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 journalArticlepeer-review


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
Issue number10
Publication statusPublished - 2008


  • Capecitabine, therapeutic use
  • Colon cancer
  • Cost effectiveness
  • Fluorouracil, therapeutic use
  • Folinic acid, therapeutic use

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology


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