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Valutazione di convenienza economica comparata tra un farmaco orale (capecitabina) e una chemioterapia parenterale a base di 5-FU (regime Mayo) nel trattamento del carcinoma del colon retto metastatizzato

  • Giovanni Giuliani
  • C. Lucioni
  • S. Mazzi
  • C. De Carli
  • C. Jamieson
Article

Economic evaluation of oral capecitabine vs intravenous 5-fluorouracil plus leucovorin (Mayo regimen) in the treatment of advanced colorectal cancer

Summary

Objective

To assess and compare the incremental healthcare resource consumption and costs in advanced colorectal cancer patients treated with oral capecitabine or intravenous chemotherapy with 5-fluorouracil plus leucovorin (5FU/LV; Mayo regimen).

Design

A cost-minimization analysis was conducted on medical resource consumption data collected in the course of a prospective, randomised, phase III clinical trial in which 602 patients with advanced colorectal cancer were treated with capecitabine or 5FU/LV Mayo regimen. Collected data concerned hospital visits for drug administration and hospital admissions, drugs and unscheduled physicians’ consultations required for the treatment of adverse events. Italian National Health Service charges and market values were used to value resources. Time horizon was 6 months and the NHS perspective was assumed.

Results

The use of capecitabine saved € 823 (17.4%) per patient over a 6-month period. In the capecitabine group the main cost driver was the drug cost (73% of total chemotherapy cost), while in the 5-FU/LV group the main cost driver was the cost of drug administration (95% of total chemotherapy cost). Treatment of adverse events accounted for 4.2% of total treatment costs in the capecitabine group and 6.8% in the 5-FU/LV group.

Conclusions

Capecitabine treatment of colorectal cancer patients results in a substantial cost saving compared to the 5-FU/LV Mayo regimen, mainly because hospital visits for intravenous administration are avoided and fewer hospitalisations are required for the treatment of adverse events.

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Bibliografia

  1. 1.
    Parkin MD, Pisani P, Ferlay J. Global cancer statistics. CA Cancer J Clin 1999; 49: 33–64PubMedCrossRefGoogle Scholar
  2. 2.
    Landis SH, Murray T, Bolden S, Wingo PA. Cancer statistics 1999. CA Cancer J Clin 1999; 49: 8–31PubMedCrossRefGoogle Scholar
  3. 3.
    Midgeley R, Kerr D. Colorectal Cancer. Lancet 1999; 353: 391–9CrossRefGoogle Scholar
  4. 4.
    Bonadonna G, Robustelli della Cuna G. Manuale di oncologia medica. Milano: Masson, 1999Google Scholar
  5. 5.
    Tomasi A. DRG in oncologia. Roma: CIC Edizioni Internazionali, 1998Google Scholar
  6. 6.
    Popescu RA, Norman A, Ross PJ, et al. Adjuvant or palliative chemotherapy for colorectal cancer on patients 70 years or older. J Clin Oncol 1999; 17(8): 2412–8PubMedGoogle Scholar
  7. 7.
    Williams NS, Northover JMA, Arnott SJ, Jass JR. Colorectal Tumours. In: Peckam MJ et al., editors. Oxford Textbook of Oncology. Oxford: Oxford University Press, 1995: 1133–68Google Scholar
  8. 8.
    International Multicentre Pooled Analysis of Colon Cancer Trials (IMPACT) Investigators. Efficacy of adjuvant fluorouracil and folinic acid in colon cancer. Lancet 1995; 345: 939–44CrossRefGoogle Scholar
  9. 9.
    Benson AB 3rd. Regional and systemic therapies for advanced colorectal carcinoma: randomized clinical trial results. Oncology (Huntingt) 1998; 12 (10 suppl. 7): 28–34Google Scholar
  10. 10.
    Cavallo MC, Gerzeli S, De Carli C, et al. Il costo del trattamento del carcinoma del colon retto in stadio avanzato. Una comparazione retrospettiva di cinque regimi chemioterapici in una divisione di oncologia clinica del Nord Italia. PharmacoEconomics — Italian Research Articles 2001; 3(1): 49–59Google Scholar
  11. 11.
    Schmoll H-J. Development of treatment for advanced colorectal cancer: infusional 5-FU and the role of new agents. Eur J Cancer 1996; 32A(suppl. 5): S18–S22PubMedCrossRefGoogle Scholar
  12. 12.
    Twelves C, Boyer M, Findlay M, et al. Capecitabine (Xeloda™) improves medical resource use compared with 5-fluorouracil plus leucovorin in a phase III trial conducted in patients with advanced colorectal carcinoma. Eur J Cancer 2001; 37: 597–604PubMedCrossRefGoogle Scholar
  13. 13.
    Ministero della Sanità. Regime di rimborsabilità e prezzo di vendita della specialità medicinale “Xeloda”, autorizzata con procedura centralizzata europea ed inserita nel registro comunitario. Decreto 1° agosto 2001, Gazzetta Ufficiale serie generale, n. 212 del 12 settembre 2001Google Scholar
  14. 14.
    L’Informatore Farmaceutico. Milano: OEMF, 2001Google Scholar
  15. 15.
    Regione Lombardia. Aggiornamento delle tariffe delle prestazioni ospedaliere in regime di ricovero e attuazione del punto 3) del dispositivo della d.g.r. n. VI/34437 del 4 febbraio 1998. D.G.R. n. VI / 37597, B.U.R.L. n. 31 del 7 agosto 1988Google Scholar
  16. 16.
    Regione Emilia-Romagna. Determinazione delle tariffe per prestazioni di assistenza ospedaliera in strutture pubbliche e private accreditate della regione Emilia-Romagna, applicabili a decorrere dall’1.1.2001. Delibera di Giunta n. 2001/1505 del 31 luglio 2001Google Scholar
  17. 17.
    Ministero della Sanità. Aggiornamento delle tariffe delle prestazioni di assistenza ospedaliera, di cui al decreto ministeriale 14 dicembre 1994. Decreto Ministeriale 12 marzo 1997, Supplemento ordinario alla Gazzetta Ufficiale n. 209 dell’8 settembre 1997Google Scholar
  18. 18.
    Lucioni C, Garancini MP, Massi-Benedetti M, et al., per conto dell’Advisory Board Italiano dello studio CODE-2. Il costo sociale del diabete di tipo 2 in Italia: lo studio CODE-2. PharmacoEconomics-Italian Research Articles 2000; 1(2): 1–21Google Scholar
  19. 19.
    Ministero della Sanità. Prestazioni di assistenza specialistica ambulatoriale erogabili nell’ambito del Servizio Sanitario Nazionale e relative tariffe. Decreto Ministeriale 22 luglio 1996, Supplemento ordinario alla Gazzetta Ufficiale n. 216 del 14 settembre 1996Google Scholar

Copyright information

© Adis International Limited 2002

Authors and Affiliations

  • Giovanni Giuliani
    • 1
  • C. Lucioni
    • 2
  • S. Mazzi
    • 2
  • C. De Carli
    • 1
  • C. Jamieson
    • 3
  1. 1.Roche SpAMonza (MI)Italia
  2. 2.ADIS InternationalMilanoItalia
  3. 3.Hoffmann-La RochePalo AltoUSA

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