Pharmacoeconomic Evaluation of Tegafur-Uracil (UFT) vs Fluorouracil for the Management of Colorectal Cancer in Brazil and Argentina
- 7 Downloads
The treatment of colorectal cancer continues to pose major challenges for oncologists throughout the world. Uracil and tegafur (UFT), as an oral agent, represents a new patient-focused approach to managing a malignancy with few treatment alternatives other than an intravenous fluorouracil (5-FU)-based regimen. The ability of UFT to achieve equivalent clinical outcomes compared with continuous 5-FU infusion, along with its oral formulation and mild toxicity profile, provide a compelling backdrop for fiscal analysis. An economic assessment of therapy attributes and effects would, therefore, be prudent and necessary when deliberating the adoption of this chemotherapy regimen.
We developed a pharmacoeconomic model in Brazil and Argentina identifying clinical practices associated with chemotherapy administration and adverse event management practices from a panel of physicians assembled in each country. Practice patterns and clinical events were then evaluated for resource utilisation trends. The perspective of this pharmacoeconomic analysis was that of the healthcare payor. Country-specific charge data were applied to the identified resources to arrive at an average cost per patient receiving a 6-cycle course of 5-FU with either levamisole and/or leucovorin as a modulator vs a modelled oral UFT/leucovorin regimen. As a comparator, the oral UFT/leucovorin regimen was modelled based on the expert panel’s input. Adverse events and incidence data were derived from clinical trial data for both agents. Both agents were analysed in the treatment of metastatic disease and as adjuvant therapy. The principal findings of a cost-minimisation analysis in Brazil revealed approximately equivalent treatment costs for both regimens in the adjuvant setting. When analysing the metastatic treatment arm, costs diverged by $R335/per patient ($R = Reals - the currency of Brazil) in favour of a UFT regimen. The profile in Argentina yielded more dramatic differences, with a UFT regimen costing $P782/per patient ($P = Pesos — the currency of Argentina) less than a 5-FU regimen in the adjuvant setting. In the treatment of metastatic disease, a UFT regimen provided $P1188/per patient in savings over a 5-FU regimen. These differences are predominantly driven by the mild toxicity profile of UFT and its corresponding less severe adverse event management practice patterns. In addition, the oral formulation of UFT versus intravenous 5-FU provides for ease of administration, lowering the total cost of care as well as likely impacting on the patient’s quality of life.
The pharmacoeconomic results suggest that a UFT regimen is a useful and economical alternative to the standard 5-FU regimen in the treatment of colorectal cancer in Brazil and Argentina.
KeywordsClin Oncol Uracil Leucovorin Levamisole Drug Invest
Unable to display preview. Download preview PDF.
- 1.Murakami M, Ota K. Clinical results of UFT therapy for malignant tumors under cooperative study. Jpn J Cancer Chemother 1980; 7: 1579–86Google Scholar
- 2.Watanabe H, Yamamoto S, Nalto T. Clinical results of oral UFT therapy under cooperative study. Jpn J Cancer Chemother 1980; 7: 1588–96Google Scholar
- 4.Hiller SA, Zhuk RA, Lidak MY. Analogs of pyrimidine nucleosides. Dokl Akad Nauk SSSR 1967; 176: 332–5Google Scholar
- 6.Fujii S, Kitano S, Ikenaka K, et al. Studies on coadministration of uracil or cytosine on antitumor activity of FT-207 or 5-FU derivatives. Jpn J Cancer Chemother 1979; 6: 377–84Google Scholar
- 8.VandeVen A, Delbecq A, Gustafson D. Group techniques for program planning. Glenview, Illinois: Scott, Foresman, 1975Google Scholar
- 10.Canadian Coordinating Office for Health Technology Assessment (CCOHTA), Guidelines for economic evaluation of pharmaceuticals. 1st ed. Ottawa, Canada: November 1994Google Scholar
- 12.Pensel R, Giangiacomo G, Breier S. 5-Fluorouracil (5FU) Associated to Folinic Acid (FA) for the Treatment of Advanced Colorectal Cancer (ACC) [Meeting Abstract]. Proc Annu Meet Am Soc Clin Oncol; 10: A446, 1991Google Scholar
- 13.Pensel R. Advanced Colon Cancer: A randomized trial of fluorouracil (5-FU) + folinic acid (FA) and 5FU+FA+Interferon alpha 2b (IFN) [Meeting Abstract]. Proc Annu Meet Am Soc Clin Oncol; 12: A602, 1993Google Scholar
- 18.Becouarn Y, Cany L, Rouhier ML, et al. High dose folinic acid (HDFA) and 5-fluorouracil (5FU) bolus and continuous infusion in advanced colorectal cancer [Meeting Abstract]. Proc Annu Meet Am Soc Clin Oncol 1994; 13: A604Google Scholar
- 19.Aranda E, Cervantes A, Dorta J, et al. A Phase II study of weekly high dose of continuous infusion of 5-fluorouracil plus leucovorin in advanced colorectal cancer [Meeting Abstract]. Proc Annu Meet Am Soc Clin Oncol 1994; 13: A594Google Scholar