Terapia orale vs terapia infusionale nel trattamento del cancro del colon retto localmente avanzato o avanzato
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Oral vs injection therapy in the treatment of metastatic colorectal cancer. A cost minimization analysis in a public hospital of the Lazio region
The aim of the study is to compare the direct medical costs associated with colorectal cancer (CRC) in a population of patients treated at Policlinico Umberto I in Rome with the two most common chemotherapy regimens: Folfox vs Xelox.
For the economic evaluation, a retrospective and observational cost minimization study has been conducted on CRC patients on chemotherapy treatment at Policlinico Umberto I in Rome, Lazio region. One-way sensitivity analysis was performed.
The average cost per patient of the equipment required for treatment administration shows high resource consumption in the Folfox arm, whilst the Xelox arm, because of oral (capecitabine) and iv (oxaliplatin) administrations, does not incur such costs. When assuming a 6 month treatment period, an average saving of about 11.5% for the Policlinico Umberto I (Lazio Regional Health Service) is observed with Xelox compared to Folfox. The one-way sensitivity analysis confirmed the advantages of oral therapy in completing a therapeutic cycle (better compliance); moreover, when in the analysis the drug price was decreased by 5%, the Xelox arm provided benefits also in the medium/short term; the analysis also confirmed the robustness of the estimates, showing that drug price is the most important cost driver.
This cost minimization analysis has shown cost savings when patients with CRC are treated, without compromising efficacy, with a chemotherapy scheme including oral drugs such as capecitabine, through savings in treatment administration. The huge costs associated with placement of central venous catheters and treatment of the related adverse events, as needed with Folfox (5-FU), in the long term offset capecitabine higher cost.
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