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Terapia orale vs terapia infusionale nel trattamento del cancro del colon retto localmente avanzato o avanzato

Analisi di minimizzazione dei costi presso una struttura ospedaliera della Regione Lazio
  • F. S. Mennini
  • A. Marcellusi
  • E. Arduini
  • G. Mauro
  • A. Mecozzi
  • A. Tuzi
  • E. Cortesi
Article
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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

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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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Bibliografia

  1. 1.
    Ferlay J, Autier P, Boniol M, et al. Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol 2007; 18: 581–92PubMedCrossRefGoogle Scholar
  2. 2.
    Rosso S, Spitale A, Balzi D, et al. Estimate of cancer incidence in Italian regions, 2001. Epidemiol Prev 2004; 28: 247–57PubMedGoogle Scholar
  3. 3.
    Zanetti R, Falcini F, Simonato L, et al. Survival of cancer patients in Italy in the nineties: the importance of population based data. Epidemiol Prev 2001; 25 (3 Suppl): 1–8PubMedGoogle Scholar
  4. 4.
    Barni S, Venturini M, Beretta GD, et al. Agreement between oncology guidelines and clinical practice in Italy: the ‘right’ program. A project of the Italian Association of Medical Oncology (AIOM). Ann Oncol 2007; 18 Suppl 6: 179–84Google Scholar
  5. 5.
    Ducreux M, Bennouna J, Hebbar M, et al. Capecitabine plus oxaliplatin (XELOX) versus 5-fluorouracil/leucovorin plus oxaliplatin (FOLFOX-6) as first-line treatment for metastatic colorectal cancer. Int J Cancer 2011; 128: 682–90PubMedCrossRefGoogle Scholar
  6. 6.
    Rothenberg ML, Cox JV, Butts C, et al. Capecitabine plus oxaliplatin (XELOX) versus 5-fluorouracil/folinic acid plus oxaliplatin (FOLFOX-4) as second-line therapy in metastatic colorectal cancer: a randomized phase III noninferiority study. Ann Oncol 2008; 19: 1720–6PubMedCrossRefGoogle Scholar
  7. 7.
    Schmoll HJ, Arnold D. Update on capecitabine in colorectal cancer. Oncologist 2006; 11: 1003–9PubMedCrossRefGoogle Scholar
  8. 8.
    Feliu J, Escudero P, Llosa F, et al. Capecitabine as first-line treatment for patients older than 70 years with metastatic colorectal cancer: an oncopaz cooperative group study. J Clin Oncol 2005; 23: 3104–11PubMedCrossRefGoogle Scholar
  9. 9.
    Gold MR, Siegel JE, Russell LB, et al. Cost-effectiveness in health and medicine. New York: Oxford University Press, 1996Google Scholar
  10. 10.
    Drummond MF, Sculpher MJ, Torrance GW, et al. (ed. it. a cura di Mennini FS, Cicchetti A, Fattore G, Russo P). Metodi per la valutazione economica dei programmi sanitari. Terza Ed. Roma; Il Pensiero Scientifico Editore, 2010Google Scholar
  11. 11.
    Agenzia per i Servizi Sanitari Regionali (ASSR). Ricoveri, personale e spesa delle aziende ospedaliere, 2003. http://www.agenas.it/agenas_pdf/AO_2003.pdf (ultimo accesso settembre 2012)
  12. 12.
    Ministero della Salute. Rapporto annuale sull’attività di Ricovero ospedaliero — Dati SDO 2003. http://www.salute.gov.it/ricoveriOspedalieri/newsRicoveriOspedalieri.jsp?id=733&menu=inevidenza&lingua=italiano (ultimo accesso settembre 2012)
  13. 13.
    Lemmers NW, Gels ME, Sleiyfer DT, et al. Complications of venous access ports in 132 patients with disseminated testicular cancer treated with polichemotherapy. J Clin Oncol 1996; 14: 2016–22Google Scholar
  14. 14.
    Rosovsky RP, Kuter DJ. Catheter-related thrombosis in cancer patients: pathophysiology, diagnosis, and management. Hematol Oncol Clin North Am 2005; 19: 183–202PubMedCrossRefGoogle Scholar
  15. 15.
    Cassidy J, Clarke S, Díaz-Rubio E, et al. Randomized phase III study of capecitabine plus oxaliplatin compared with fluorouracil/folinic acid plus oxaliplatin as first-line therapy for metastatic colorectal cancer. J Clin Oncol 2008; 26: 2006–12PubMedCrossRefGoogle Scholar
  16. 16.
    Giuliani G, Lucioni C, Mazzi S, et al. Valutazione di convenienza economica comparata tra un farmaco orale (capecitabina) e una terapia parenterale a base di 5-FU (regime Mayo) nel trattamento del carcinoma del colonretto metastizzato. PharmacoEconomics-Italian Research Articles 2002; 4: 31–8CrossRefGoogle Scholar
  17. 17.
    Aitini E, Rossi A, Morselli P, et al. Economic comparison of capecitabine + oxaliplatin and 5-fluorouracil + oxaliplatin in the adjuvant treatment of colon cancer. Cancer Manag Res 2012; 4: 99–103PubMedGoogle Scholar
  18. 18.
    Ward S, Kaltenthaler E, Cowan J, et al. Clinical and costeffectiveness of capecitabine and tegafur with uracil for the treatment of metastatic colorectal cancer: systematic review and economic evaluation. Health Technol Assess 2003; 7: 1–93PubMedGoogle Scholar
  19. 19.
    Limat S, Bracco-Nolin CH, Legat-Fagnoni C, et al. Economic impact of simplified de Gramont regimen in first-line therapy in metastatic colorectal cancer. Eur J Health Econ 2006;7: 107–13PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2012

Authors and Affiliations

  • F. S. Mennini
    • 1
    • 5
  • A. Marcellusi
    • 1
    • 5
  • E. Arduini
    • 2
  • G. Mauro
    • 2
  • A. Mecozzi
    • 3
  • A. Tuzi
    • 4
  • E. Cortesi
    • 4
  1. 1.CEIS Sanità — Centre for Health Economics and Management (CHEM)Università di Roma “Tor Vergata”RomaItalia
  2. 2.Farmacia Policlinico Umberto IRoma
  3. 3.ASL RM/AItaly
  4. 4.Facoltà di MedicinaUniversità “La Sapienza”Roma
  5. 5.Facoltà di StatisticaUniversità “La Sapienza”Roma

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