Pharmacoeconomic analysis of adjuvant oral capecitabine vs intravenous 5-FU/LV in Dukes' C colon cancer:: the X-ACT trial

被引:94
作者
Cassidy, J
Douillard, Y
Twelves, C
McKendrick, JJ
Scheithauer, W
Bustová, I
Johnston, PG
Lesniewski-Kmak, L
Jelic, S
Fountzilas, G
Coxon, F
Díaz-Rubio, E
Maughan, TS
Malzyner, A
Bertetto, O
Beham, A
Figer, A
Dufour, P
Patel, KK
Cowell, W
Garrison, LP
机构
[1] Univ Glasgow, Canc Res UK, Dept Med Oncol, Glasgow G61 1DB, Lanark, Scotland
[2] Ctr Rene Gauducheau, F-44805 Nantes, France
[3] Univ Bradford, Tom Connors Canc Res Ctr, Bradford BD7 1DP, W Yorkshire, England
[4] Box Hill Hosp, Dept Oncol, Melbourne, Vic, Australia
[5] Med Univ Wien, Innere Med Klin 1, A-1090 Vienna, Austria
[6] Nemocnice Ceske Budejovice, Klin Onkol, Ceske Budejovice 37087 C, Czech Republic
[7] Queens Univ Belfast, Dept Oncol, Canc Res Ctr, Belfast BT9 7AB, Antrim, North Ireland
[8] PCK Maritime Hosp, Med Oncol & Radiotherapy Dept, PL-81519 Gdynia, Poland
[9] Inst Oncol & Radiol Serbia, Belgrade 11000, Serbia Monteneg
[10] Aristotle Univ Thessaloniki, Dept Med Oncol, Papageorgiou Hosp, Sch Med, GR-54006 Thessaloniki, Greece
[11] Newcastle Gen Hosp, No Ctr Canc Treatment, Newcastle Upon Tyne NE4 6BE, Tyne & Wear, England
[12] Hosp Univ San Carlos, Madrid 28040, Spain
[13] Velindre Hosp, Cardiff CF4 7XL, Wales
[14] SC Ltda, Clin Oncol Med, BR-01406100 Sao Paulo, Brazil
[15] Osped S Giovanni Battista Sede Molinette, COES, I-12126 Turin, Italy
[16] Univ Klinikum Regensberg, Klin & Poliklin Chirurg, D-93053 Regensburg, Germany
[17] Elias Sourasky Med Ctr, Inst Oncol, IL-64239 Tel Aviv, Israel
[18] Ctr Lutte Contre Canc Paul Strauss, F-67065 Strasbourg, France
[19] Hoffmann La Roche Inc, Nutley, NJ 07110 USA
[20] Roche UK, Welwyn Garden City, Herts, England
[21] Univ Washington, Seattle, WA 98195 USA
关键词
capecitabine; 5-fluorouracil/leucovorin; adjuvant; colon cancer; pharmacoeconomics; cost-effectiveness;
D O I
10.1038/sj.bjc.6603059
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Oral capecitabine (Xeloda (R)) is an effective drug with favourable safety in adjuvant and metastatic colorectal cancer. Oxaliplatinbased therapy is becoming standard for Dukes' C colon cancer in patients suitable for combination therapy, but is not yet approved by the UK National Institute for Health and Clinical Excellence (NICE) in the adjuvant setting. Adjuvant capecitabine is at least as effective as 5-fluorouracil/leucovorin (5-FU/LV), with significant superiority in relapse-free survival and a trend towards improved disease-free and overall survival. We assessed the cost-effectiveness of adjuvant capecitabine from payer (UK National Health Service (NHS)) and societal perspectives. We used clinical trial data and published sources to estimate incremental direct and societal costs and gains in quality-adjusted life months (QALMs). Acquisition costs were higher for capecitabine than 5-FU/LV, but higher 5-FU/LV administration costs resulted in 57% lower chemotherapy costs for capecitabine. Capecitabine vs 5-FU/LV-associated adverse events required fewer medications and hospitalisations (cost savings 3653) pound. Societal costs, including patient travel/time costs, were reduced by > 75% with capecitabine vs 5-FU/LV (cost savings 1318) pound, with lifetime gain in QALMs of 9 months. Medical resource utilisation is significantly decreased with capecitabine vs 5-FU/LV, with cost savings to the NHS and society. Capecitabine is also projected to increase life expectancy vs 5-FU/LV. Cost savings and better outcomes make capecitabine a preferred adjuvant therapy for Dukes' C colon cancer. This pharmacoeconomic analysis strongly supports replacing 5-FU/LV with capecitabine in the adjuvant treatment of colon cancer in the UK.
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收藏
页码:1122 / 1129
页数:8
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