Costs Associated With Complications Are Lower With Capecitabine Than With 5-Fluorouracil in Patients With Colorectal Cancer

BACKGROUND: Capecitabine, an oral alternative to 5-fluorouracil (5-FU) in patients with colorectal cancer (CRC), has equal clinical efficacy and a favorable safety profile; however, its use may be limited because of unit cost concerns. In this study, the authors measured the cost of chemotherapy-related complications during treatment with capecitabine- and 5-FU-based regimens. METHODS: Patients with CRC who received at least 1 administration of capecitabine or 5-FU during 2004 and 2005 were identified from the Thomson MarketScan research databases. Monthly frequency and cost for 23 complications were recorded. Logistic regression was used to predict complication probability. General linear models were used to predict monthly complication cost and total monthly expenditure. RESULTS: In total, 4973 patients with CRC met the inclusion criteria for this analysis. Although the most frequently observed complications were the same between capecitabine and 5-FU (nausea and vomiting, infection, anemia, neutropenia, diarrhea), each was observed with greater frequency in 5-FU-based regimens. The mean predicted monthly complication cost was significantly higher (by 136%) with 5-FU monotherapy than with capecitabine monotherapy (difference, $601; 95% confidence interval [95% CI], $469-$737). In addition, the mean predicted monthly complication cost for 5-FU+oxaliplatin was higher than the cost with capecitabine plus oxaliplatin (difference, $1165; 95% CI, $892-$1595). When acquisition, administration, and complication costs were taken into consideration, there were no significant differences in the total cost between capecitabine regimens and 5-FU regimens. CONCLUSIONS: Capecitabine compared well with 5-FU-based therapy in patients with CRC and was associated with lower complication rates and associated costs. Cancer 2009;115:1412-23. (C) 2009 American Cancer Society.