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Oral capecitabine (Xeloda) is an effective drug with favourable safety in adjuvant and metastatic colorectal cancer. Oxaliplatin-based therapy is becoming standard for Dukes' C colon cancer in patients suitable for combination therapy, but is not yet approved by the UK National Institute for Health and Clinical Excellence (NICE) in the adjuvant setting. Adjuvant capecitabine is at least as effective as 5-fluorouracil/leucovorin (5-FU/LV), with significant superiority in relapse-free survival and a trend towards improved disease-free and overall survival. We assessed the cost-effectiveness of adjuvant capecitabine from payer (UK National Health Service (NHS)) and societal perspectives. We used clinical trial data and published sources to estimate incremental direct and societal costs and gains in quality-adjusted life months (QALMs). Acquisition costs were higher for capecitabine than 5-FU/LV, but higher 5-FU/LV administration costs resulted in 57% lower chemotherapy costs for capecitabine. Capecitabine vs 5-FU/LV-associated adverse events required fewer medications and hospitalisations (cost savings pound3653). Societal costs, including patient travel/time costs, were reduced by >75% with capecitabine vs 5-FU/LV (cost savings pound1318), with lifetime gain in QALMs of 9 months. Medical resource utilisation is significantly decreased with capecitabine vs 5-FU/LV, with cost savings to the NHS and society. Capecitabine is also projected to increase life expectancy vs 5-FU/LV. Cost savings and better outcomes make capecitabine a preferred adjuvant therapy for Dukes' C colon cancer. This pharmacoeconomic analysis strongly supports replacing 5-FU/LV with capecitabine in the adjuvant treatment of colon cancer in the UK.

Original publication

DOI

10.1038/sj.bjc.6603059

Type

Journal article

Journal

Br J Cancer

Publication Date

24/04/2006

Volume

94

Pages

1122 - 1129

Keywords

Administration, Oral, Antineoplastic Combined Chemotherapy Protocols, Capecitabine, Chemotherapy, Adjuvant, Colonic Neoplasms, Cost-Benefit Analysis, Deoxycytidine, Disease-Free Survival, Drug Administration Schedule, Drug Costs, Fluorouracil, Health Care Costs, Health Resources, Humans, Injections, Intravenous, Leucovorin, Neoplasm Staging, Quality of Life, Remission Induction, Sensitivity and Specificity, Survival Rate, Time Factors, Treatment Outcome, United Kingdom