XELOX versus FOLFOX6 as an adjuvant treatment in colorectal cancer: an economic analysis

ABSTRACT

Objectives: An economic analysis (based on interim data from a long-term, randomised, multi-centre, controlled, clinical trial) to evaluate chemotherapy with XELOX (capecitabine/oxaliplatin) versus FOLFOX6 (5Fluorouracil/leucovorin/oxaliplatin) as an adjuvant treatment for high risk colorectal cancer patients in Greece.

Methods: As survival rate was the same in the two arms, a cost-minimisation analysis was carried out, from the perspectives of the National Health Service (NHS), Social Insurance Funds (SIF) and patients in Greece. Patient data were combined with 2008 unit prices to estimate the total cost of patient care, the patients’ travelling expenditure and their productivity losses. Raw data were bootstrapped 5000 times in order to allow statistical testing.

Results: From an NHS perspective, the mean chemotherapy cost was €8762 with FOLFOX6 and €9713 with XELOX; costs of administration and hospitalisations were €5154 and €1050, respectively. Total treatment cost with FOLFOX6 reached €17 480 and with XELOX €12 525, a difference of €4955 (p < 0.001) in favour of the latter therapy. From an SIF perspective, the total cost of treatment was €16 240 with FOLFOX6 and €12 617 with XELOX, a reduction of €3623 (p < 0.001) with the latter therapy. Mean patient travelling cost was €184 with FOLFOX6 and €80 with XELOX, a difference of €104 (p < 0.001). Mean productivity loss was €100 with FOLFOX6 and €31 with XELOX, a difference of €69 (p < 0.001).

Conclusions: Chemotherapy combining oral capecitabine and oxaliplatin reduces total treatment cost for the Greek National Health Service and Social Insurance Funds, mainly through a reduction in the cost of administration. From patients’ perspective, it reduces travelling expenditure and productivity losses. Therefore, this combination may be a cost-effective approach for the management of colorectal cancer patients who have had surgery in Greece. This is an analysis alongside a clinical trial, and should be interpreted in this specific context in which it was undertaken.

Key words: :

• Capecitabine
• Colorectal cancer
• Economics
• FOLFOX
• XELOX

Acknowledgements

Declaration of interest: The publication of this article was supported by the Hellenic Cooperative Oncology Group (HECOG). The authors D.P. and G.F. are members of HECOG. Roche, the manufacturer of capecitabine, has, in the past, provided unrestricted grants to HECOG in general support of the foundation, but has not specifically funded this economic study or the clinical trial that it is based on. The authors have not received any financial benefit from HECOG or from Roche for the preparation of this article and declare that they have no conflicting relationships with Roche. Roche has had no role in the preparation of this article. N.M. and V.F have acted as external analysts on the economics aspects of the study on behalf of HECOG, and have not received any financial support for this contribution. The authors acknowledge the contribution of Philip Lees, Technical Director, Hellenic Journal of Cardiology, in the editing of the article.