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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

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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.

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Notes

  1. The use of trade names is for product identification purposes only and does not imply endorsement.

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Acknowledgements

This study was sponsored by Roche SpA, Monza, Italy. English language assistance for the preparation of this manuscript was provided by Tracey Hale, Wolters Kluwer Medical Communications. This assistance was funded by Roche SpA, Monza, Italy.

Co-contributors: Antimi Mauro, Ospedale S. Eugenio, Roma; Beretta Giordano, Ospedali Riuniti, Bergamo; Bertuccelli Maurizio, Azienda USL 6, Livorno; Biasco Guido, Policlinico S. Orsola Malpighi, Bologna; Brandi Giovanni, Policlinico S. Orsola Malpighi, Bologna; Bumma Cesare, Ospedale S. Giovanni AS, Torino; Cardarelli Nadia, Ospedale Vicenza, Vicenza; Ciuffreda Libero, Az. Sanitaria Ospedaliera Molinette, Torino; Comella Giuseppe, Istituto Tumori Fondazione Pascale, Napoli; Della Palma Maurizio, Ospedale Vicenza, Vicenza; Fosser Vinicio, Ospedale Vicenza, Vicenza; Frustaci Sergio, Centro Riferimento Oncologico, Aviano; Paccagnella Adriano, USL 6 Ospedale Civile, Venezia; Rabbi Carla, Az. Ospedaliera C. Poma, Poma; Ricci Sergio, Az. Ospedaliera S. Chiara, Pisa; Rosso Riccardo, Istituto Nazionale Ricerca Cancro, Genova; Scanni Alberto, Az. Ospedaliera Fatebenefratelli, Milano.

The authors have no conflicts of interest that are directly relevant to the content of this study.

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Authors and Affiliations

  1. Unità Complessa di Oncologia Medica, Azienda Ospedaliero-Universitaria Careggi, Viale Pieraccini 17, 50139, Florence, Italy

    Francesco Di Costanzo, Lorenzo Antonuzzo & Silvia Gasperoni

  2. Adis | Wolters Kluwer Health, Milan, Italy

    Roberto Ravasio

  3. Oncologia Medica, Ospedale S. Martino, Genoa, Italy

    Alberto Sobrero

  4. Oncologia Medica, Az. Sanitaria Ospedaliera Molinette, Turin, Italy

    Oscar Bertetto

  5. Divisione Oncologia Medica, USL 17 Ospedale Civile, Noale (VE), Italy

    Orazio Vinante

  6. Azienda Ospedaliero-Universitaria, Modena, Italy

    Gabriele Luppi

  7. U.O. Oncologia Medica Ospedali Riuniti, Bergamo, Italy

    Roberto Labianca

  8. Istututo Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola (FC), Italy

    Dino Amadori

  9. Divisione Oncologia Medica, Università Cattolica S. Cuore, Rome, Italy

    Carlo Barone

  10. Oncologia Medica, Azienda Ospedale S. Cuore, Cuneo, Italy

    Marco Carlo Merlano

  11. Oncologia, Università Policlinico Umberto I, Rome, Italy

    Flavia Longo

  12. Oncologia, Ospedale Civile, Sora (FR), Italy

    Giovanni Mansueto

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  1. Francesco Di Costanzo
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  2. Roberto Ravasio
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  3. Alberto Sobrero
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  4. Oscar Bertetto
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  5. Orazio Vinante
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  7. Roberto Labianca
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  8. Dino Amadori
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  9. Carlo Barone
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  10. Marco Carlo Merlano
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  11. Flavia Longo
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  12. Giovanni Mansueto
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  13. Lorenzo Antonuzzo
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  14. Silvia Gasperoni
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Corresponding author

Correspondence to Francesco Di Costanzo.

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Di Costanzo, F., Ravasio, R., Sobrero, A. et al. Capecitabine versus Bolus Fluorouracil plus Leucovorin (Folinic Acid) as Adjuvant Chemotherapy for Patients with Dukes’ C Colon Cancer. Clin. Drug Investig. 28, 645–655 (2008). https://doi.org/10.2165/00044011-200828100-00005

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  • DOI: https://doi.org/10.2165/00044011-200828100-00005

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