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Phisalprapa P, Kositamongkol C, Korphaisarn K, Akewanlop C, Srimuninnimit V, Supakankunti S, Apiraksattayakul N, Chaiyakunapruk N. Cost-Utility and Budget Impact Analyses of Oral Chemotherapy for Stage III Colorectal Cancer: Real-World Evidence after Policy Implementation in Thailand. Cancers (Basel) 2023; 15:4930. [PMID: 37894297 PMCID: PMC10605760 DOI: 10.3390/cancers15204930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/03/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
This study conducted a cost-utility analysis and a budget impact analysis (BIA) of outpatient oral chemotherapy versus inpatient intravenous chemotherapy for stage III colorectal cancer (CRC) in Thailand. A Markov model was constructed to estimate the lifetime cost and health outcomes based on a societal perspective. Eight chemotherapy strategies were compared. Clinical and cost data on adjuvant chemotherapy were collected from the medical records of 1747 patients at Siriraj Hospital, Thailand. The cost-effectiveness results were interpreted against a Thai willingness-to-pay threshold of USD 5003/quality-adjusted life year (QALY) gained. A 5-year BIA was performed. Of the eight strategies, CAPOX then FOLFIRI yielded the highest life-year and QALY gains. Its total lifetime cost was also the highest. An incremental cost-effectiveness ratio of CAPOX then FOLFIRI compared to 5FU/LV then FOLFOX, a commonly used regimen USD was 4258 per QALY gained.The BIA showed that when generic drug prices were applied, 5-FU/LV then FOLFOX had the smallest budgetary impact (USD 9.1 million). CAPOX then FOLFIRI required an approximately three times higher budgetary level (USD 25.1 million). CAPOX then FOLFIRI is the best option. It is cost-effective compared with 5-FU/LV then FOLFOX. However, policymakers should consider the relatively high budgetary burden of the CAPOX then FOLFIRI regimen.
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Affiliation(s)
- Pochamana Phisalprapa
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Chayanis Kositamongkol
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Krittiya Korphaisarn
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Charuwan Akewanlop
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Vichien Srimuninnimit
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Siripen Supakankunti
- Centre of Excellence for Health Economics, Faculty of Economics, Chulalongkorn University, Bangkok 10330, Thailand
| | | | - Nathorn Chaiyakunapruk
- College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT 84108, USA
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Naghsh-Nejad M, Yu S, Haywood P. Provider responses to the expansion of public subsidies in healthcare: The case of oral chemotherapy treatment in Australia. Soc Sci Med 2023; 330:116041. [PMID: 37429170 DOI: 10.1016/j.socscimed.2023.116041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 05/19/2023] [Accepted: 06/16/2023] [Indexed: 07/12/2023]
Abstract
We examine provider responses to the expansion of public subsidies in 2015 for innovative oral chemotherapy treatment, in a health system where providers were free to determine their own prices. The new treatment was known to have similar efficacy to its traditional intravenous alternative and was preferred by patients for its at-home administration. However, from a policymaker's perspective, the potential for misalignment between patient and provider preferences was significant given the shift to full reimbursement for the oral chemotherapy medication but no change in fee-for-service payments for associated chemotherapy services. Under this scenario, a shift away from traditional intravenous chemotherapy may entail reduced activity and revenues associated with infusions for providers, and we hypothesise that it may result in unintended policy consequences such as reduced take-up of the new therapy or higher prices. We implement a difference-in-difference model using national administrative data on services provided, and chemotherapy medications prescribed, by providers to 1850 patients in New South Wales, Australia. Our estimates indicate that the subsidies expanded access to oral chemotherapy for newly eligible patients by 15 percentage points. However, prices charged by providers for an episode of care rose by 23 percent, driven mostly by increases in service volumes. The results illustrate the importance of understanding differential provider responses to policy changes in financial incentives.
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Affiliation(s)
- Maryam Naghsh-Nejad
- Centre for Health Economics Research and Evaluation, Faculty of Health, University of Technology Sydney, Australia
| | - Serena Yu
- Centre for Health Economics Research and Evaluation, Faculty of Health, University of Technology Sydney, Australia.
| | - Philip Haywood
- Centre for Health Economics Research and Evaluation, Faculty of Health, University of Technology Sydney, Australia
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To YH, Gibbs P, Tie J, IJzerman M, Degeling K. Health economic evidence for adjuvant chemotherapy in stage II and III colon cancer: a systematic review. Cost Eff Resour Alloc 2023; 21:11. [PMID: 36721219 PMCID: PMC9887815 DOI: 10.1186/s12962-023-00422-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 01/23/2023] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE The aims of this study was to appraise the health economic evidence for adjuvant chemotherapy (AC) strategies in stage II and III colon cancer (CC) and identify gaps in the available evidence that might inform further research. METHOD A systematic review of published economic evaluations was undertaken. Four databases were searched and full-text publications in English were screened for inclusion. A narrative synthesis was performed to summarise the evidence. RESULTS Thirty-eight studies were identified and stratified by cancer stage and AC strategy. The majority (89%) were full economic evaluations considering both health outcomes, usually measured as quality-adjusted life years (QALYs), and costs. AC was found to be cost-effective compared to no AC for both stage II and III CC. Oral and oxaliplatin-based AC was cost-effective for stage III. Three months of CAPOX was cost-effective compared to 6-month in high-risk stage II and stage III CC. Preliminary evidence suggests that biomarker approaches to AC selection in stage II can reduce costs and improve health outcomes. Notably, assessment of QALYs were predominantly reliant on a small number of non-contemporary health-utility studies. Only 32% of studies considered societal costs such as travel and time off work. CONCLUSIONS Published economic evaluations consistently supported the use of AC in stage II and III colon cancer. Biomarker-driven approaches to patient selection have great potential to be cost-effective, but more robust clinical and economic evidence is warranted. Patient surveys embedded into clinical trials may address critical knowledge gaps regarding accurate assessment of QALYs and societal costs in the modern era.
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Affiliation(s)
- Yat Hang To
- grid.1042.70000 0004 0432 4889Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia ,grid.1055.10000000403978434Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Peter Gibbs
- grid.1042.70000 0004 0432 4889Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia ,grid.417072.70000 0004 0645 2884Department of Medical Oncology, Western Health, Melbourne, Australia ,grid.1008.90000 0001 2179 088XFaculty of Medicine and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Jeanne Tie
- grid.1042.70000 0004 0432 4889Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia ,grid.1055.10000000403978434Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia ,grid.1008.90000 0001 2179 088XFaculty of Medicine and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Maarten IJzerman
- grid.1008.90000 0001 2179 088XCancer Health Services Research, Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia ,grid.1008.90000 0001 2179 088XCancer Health Services Research, Centre for Health Policy, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia ,grid.1055.10000000403978434Department of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Koen Degeling
- grid.1008.90000 0001 2179 088XCancer Health Services Research, Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia ,grid.1008.90000 0001 2179 088XCancer Health Services Research, Centre for Health Policy, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
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Bloem LT, De Abreu Lourenço R, Chin M, Ly B, Haas M. Factors Impacting Treatment Choice in the First-Line Treatment of Colorectal Cancer. Oncol Ther 2016; 4:103-116. [PMID: 28261643 PMCID: PMC5315063 DOI: 10.1007/s40487-016-0020-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION To investigate the factors that affect the choice of 5-fluorouracil (5-FU) or its oral alternative, capecitabine, as first-line treatment in patients with colorectal cancer (CRC). METHODS Patients treated with 5-FU or capecitabine for CRC between January 1, 2011 and December 31, 2013 in a teaching hospital in the Sydney metropolitan area, Australia were identified using the hospital's database MOSAIQ®. The electronic medical record of each patient was manually reviewed to extract factors potentially affecting treatment choice. Logistic regression was used to assess which patient and/or treatment factors could explain the choice between 5-FU or capecitabine. Where it was available in the medical correspondence, the explicit reason for the choice made was extracted. RESULTS 170 CRC patients were included; 119 on 5-FU, and 51 on capecitabine. The odds of receiving capecitabine as a first-line treatment were positively associated with giving patients a choice in the decision (OR = 17.51, 95% CI: 5.37-57.08). Qualitative data suggest treatment choices were motivated by convenience (oral administration) and tolerability. Time from diagnosis to treatment commencement (OR = 1.02 per month, 95% CI 1.00-1.04) was also found to be positively associated with the choice of capecitabine. The odds of being treated with capecitabine were lower for patients who lived further from the treating hospital (OR = 0.22, 95% CI 0.05-0.94). CONCLUSION This study suggests that patient choice, favoring oral capecitabine over i.v. 5-FU, was a key factor influencing first-line treatment for CRC in this cohort. To respect their autonomy, patients should be involved in the clinical decision making process.
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Affiliation(s)
- Lourens T Bloem
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
| | - Richard De Abreu Lourenço
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Block D, Building 5, 1 Quay St, Haymarket, NSW 2007 Australia
| | - Melvin Chin
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, High St, Randwick, NSW 2031 Australia
| | - Brett Ly
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, High St, Randwick, NSW 2031 Australia
| | - Marion Haas
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Block D, Building 5, 1 Quay St, Haymarket, NSW 2007 Australia
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Soni A, Chu E. Cost-Effectiveness of Adjuvant Chemotherapy in the Treatment of Early-Stage Colon Cancer. Clin Colorectal Cancer 2015; 14:219-26. [DOI: 10.1016/j.clcc.2015.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 04/10/2015] [Accepted: 05/15/2015] [Indexed: 10/23/2022]
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Graham CN, Hechmati G, Hjelmgren J, de Liège F, Lanier J, Knox H, Barber B. Cost-effectiveness analysis of panitumumab plus mFOLFOX6 compared with bevacizumab plus mFOLFOX6 for first-line treatment of patients with wild-type RAS metastatic colorectal cancer. Eur J Cancer 2014; 50:2791-801. [PMID: 25219451 DOI: 10.1016/j.ejca.2014.08.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 06/05/2014] [Accepted: 08/05/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the cost-effectiveness of panitumumab plus mFOLFOX6 (oxaliplatin, 5-fluorouracil and leucovorin) compared with bevacizumab plus mFOLFOX6 in first-line treatment of patients with wild-type RAS metastatic colorectal cancer (mCRC). DESIGN A semi-Markov model was constructed from a French health collective perspective, with health states related to first-line treatment (progression-free), disease progression with and without subsequent active treatment, resection of metastases, disease-free after successful resection and death. METHODS Parametric survival analyses of patient-level progression-free and overall survival data from the only head-to-head clinical trial of panitumumab and bevacizumab (PEAK) were performed to estimate transitions to disease progression and death. Additional data from PEAK informed the amount of each drug consumed, duration of therapy, subsequent therapy use, and toxicities related to mCRC treatment. Literature and French public data sources were used to estimate unit costs associated with treatment and duration of subsequent active therapies. Utility weights were calculated from patient-level data from panitumumab trials in the first-, second- and third-line settings. A life-time perspective was applied. Scenario, one-way, and probabilistic sensitivity analyses were performed. RESULTS Based on a head-to-head clinical trial that demonstrates better efficacy outcomes for patients with wild-type RAS mCRC who receive panitumumab plus mFOLFOX6 versus bevacizumab plus mFOLFOX6, the incremental cost per life-year gained was estimated to be €26,918, and the incremental cost per quality-adjusted life year (QALY) gained was estimated to be €36,577. Sensitivity analyses indicate the model is robust to alternative parameters and assumptions. CONCLUSIONS The incremental cost per QALY gained indicates that panitumumab plus mFOLFOX6 represents good value for money in comparison to bevacizumab plus mFOLFOX6 and, with a willingness-to-pay ranging from €40,000 to €60,000, can be considered cost-effective in first-line treatment of patients with wild-type RAS mCRC.
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Affiliation(s)
| | - Guy Hechmati
- Global Health Economics, Amgen (Europe) GmbH, Dammstrasse 23, Zug, Switzerland.
| | - Jonas Hjelmgren
- Global Health Economics, Amgen (Europe) GmbH, Dammstrasse 23, Zug, Switzerland.
| | - Frédérique de Liège
- Value and Access, Amgen SAS, 62 Bvd Victor Hugo, 92423 Neuilly sur Seine, France.
| | - Julie Lanier
- Value and Access, Amgen SAS, 62 Bvd Victor Hugo, 92423 Neuilly sur Seine, France.
| | - Hediyyih Knox
- RTI Health Solutions, 200 Park Offices Drive, Research Triangle Park, NC, USA.
| | - Beth Barber
- Global Health Economics, Amgen, Inc., Amgen Center Drive 1, Thousand Oaks, CA, USA.
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Soni A, Aspinall SL, Zhao X, Good CB, Cunningham FE, Chatta G, Passero V, Smith KJ. Cost-Effectiveness Analysis of Adjuvant Stage III Colon Cancer Treatment at Veterans Affairs Medical Centers. Oncol Res 2014; 22:311-9. [PMID: 26629943 PMCID: PMC7842555 DOI: 10.3727/096504015x14424348426152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The objective of this study was to evaluate the real-world cost effectiveness of adjuvant stage III colon cancer chemotherapy regimens, given that previous analyses have been based on data from clinical trials. The study was designed using integrated decision tree and Markov model, which was developed to evaluate the cost effectiveness of 5-fluorouracil/leucovorin (5-FU/LV), capecitabine, and the combination of each with oxaliplatin. The analysis was performed from a US Veterans Affairs perspective via retrospectively collected data, over a 5-year model time horizon. Outcome and cost data were used to calculate cost per quality adjusted life year (QALY), and one-way and probabilistic sensitivity analyses were performed. In the base case analysis, capecitabine and capecitabine plus oxaliplatin both cost more and were less effective than other regimens, and 5-FU/LV plus oxaliplatin, compared to 5-FU/LV alone, resulted in a cost of $25,997 per QALY gained. Model results were generally robust to parameter variation. Capecitabine plus oxaliplatin could be economically reasonable if full dosing occurred ≥76% of the time (base case 42%). In a real-world setting, the addition of oxaliplatin to 5-FU/LV is more effective but also more costly than 5-FU/LV alone. If full dosing of capecitabine-containing regimens can be assured, they may also be cost-effective strategies.
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Affiliation(s)
- Amy Soni
- *University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Sherrie L. Aspinall
- †VA Pharmacy Benefits Management Services, Hines, IL, USA
- ‡VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- §University of Pittsburgh, School of Pharmacy, Pittsburgh, PA, USA
| | - Xinhua Zhao
- ‡VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Chester B. Good
- †VA Pharmacy Benefits Management Services, Hines, IL, USA
- ‡VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- §University of Pittsburgh, School of Pharmacy, Pittsburgh, PA, USA
- ¶University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | | | | | - Vida Passero
- **VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Kenneth J. Smith
- ††University of Pittsburgh, Division of Clinical Modeling and Decision Sciences, Pittsburgh, PA, USA
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van Gils C, de Groot S, Tan S, Redekop W, Koopman M, Punt C, Uyl-de Groot C. Real-world resource use and costs of adjuvant treatment for stage III colon cancer. Eur J Cancer Care (Engl) 2013; 24:321-32. [DOI: 10.1111/ecc.12154] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2013] [Indexed: 11/29/2022]
Affiliation(s)
- C.W.M. van Gils
- Institute for Medical Technology Assessment; Erasmus University Rotterdam; Rotterdam
| | - S. de Groot
- Institute for Medical Technology Assessment; Erasmus University Rotterdam; Rotterdam
| | - S.S. Tan
- Institute for Medical Technology Assessment; Erasmus University Rotterdam; Rotterdam
| | - W.K. Redekop
- Institute for Medical Technology Assessment; Erasmus University Rotterdam; Rotterdam
| | - M. Koopman
- Department of Medical Oncology; University Medical Center Utrecht; Utrecht
| | - C.J.A. Punt
- Department of Medical Oncology; Academic Medical Center; University of Amsterdam; Amsterdam
| | - C.A. Uyl-de Groot
- Institute for Medical Technology Assessment; Erasmus University Rotterdam; Rotterdam
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Recommendations and expert opinion on the adjuvant treatment of colon cancer in Spain. Clin Transl Oncol 2012; 13:798-804. [PMID: 22082644 DOI: 10.1007/s12094-011-0736-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Adjuvant chemotherapy is the current standard in the management of patients with localised colon cancer (CC) following curative resection. The use of oxaliplatin plus 5 fluorouracil/leucovorin (FOLFOX) or oxaliplatin plus capecitabine-based (XELOX) regimens, both approved in Europe as adjuvant treatment for stage III CC, has improved prognosis in this stage, but questions on their usefulness in high-risk stage II or elderly CC patients and on the role of some prognostic biomarkers are still pending. In April 2010, a consensus meeting on adjuvant CC treatment based on a revision of the most recent literature was held in Spain. The panel considered the use of adjuvant chemotherapy for high-risk stage II CC patients to be justified. Additionally, the more convenient administration of oral fluoropyrimidines vs. IV continuous infusion 5-FU would make XELOX a more suitable alternative for the patient. A more cautious decision should be taken when prescribing oxaliplatin treatment in patients aged ≥70.
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Banna GL, Collovà E, Gebbia V, Lipari H, Giuffrida P, Cavallaro S, Condorelli R, Buscarino C, Tralongo P, Ferraù F. Anticancer oral therapy: emerging related issues. Cancer Treat Rev 2010; 36:595-605. [PMID: 20570443 DOI: 10.1016/j.ctrv.2010.04.005] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 04/10/2010] [Accepted: 04/25/2010] [Indexed: 11/23/2022]
Abstract
The use of oral anticancer drugs has shown a steady increase. Most patients prefer anticancer oral therapy to intravenous treatment primarily for the convenience of a home-based therapy, although they require that the efficacy of oral therapy must be equivalent and toxicity not superior than those expected with the intravenous treatment. A better patient compliance, drug tolerability, convenience and possible better efficacy for oral therapy as compared to intravenous emerge as the major reasons to use oral anticancer agents among oncologists. Inter- and intra-individual pharmacokinetic variations in the bioavailability of oral anticancer drugs may be more relevant than for intravenous agents. Compliance is particularly important for oral therapy because it determines the dose-intensity of the treatment and ultimately treatment efficacy and toxicity. Patient stands as the most important determinant of compliance. Possible measures for an active and safe administration of oral therapy include a careful preliminary medical evaluation and selection of patients based on possible barriers to an adequate compliance, pharmacologic issues, patient-focused education, an improvement of the accessibility to healthcare service, as well as the development of home-care nursing symptom-focused interventions. Current evidences show similar quality of life profile between oral and intravenous treatments, although anticancer oral therapy seems to be more convenient in terms of administration and reduced time lost for work or other activities. Regarding cost-effectiveness, current evidences are in favor of oral therapy, mainly due to reduced need of visits and/or day in hospital for the administration of the drug and/or the management of adverse events.
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Affiliation(s)
- Giuseppe Luigi Banna
- Division of Medical Oncology, Vittorio Emanuele University Hospital, Via Plebiscito, 628, 95124 Catania, Italy.
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Chu E, Schulman KL, McKenna EF, Cartwright T. Patients With Locally Advanced and Metastatic Colorectal Cancer Treated With Capecitabine Versus 5-Fluorouracil as Monotherapy or Combination Therapy With Oxaliplatin: A Cost Comparison. Clin Colorectal Cancer 2010; 9:229-37. [DOI: 10.3816/ccc.2010.n.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Yun JA, Kim HC, Son HS, Kim HR, Yun HR, Cho YB, Yun SH, Lee WY, Chun HK. Oncologic outcome after cessation or dose reduction of capecitabine in patients with colon cancer. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2010; 26:287-92. [PMID: 21152231 PMCID: PMC2998011 DOI: 10.3393/jksc.2010.26.4.287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 06/27/2010] [Indexed: 01/03/2023]
Abstract
Purpose Oral capecitabine has been used as adjuvant therapy for colorectal cancer patients since the 1990s. Patient-initiated cessation or reduced use of capecitabine occurs widely for various reasons, yet the consequences of these actions are unclear. The present study sought to clarify treatment outcomes in such patients. Methods The study included 173 patients who had been diagnosed with stage II or III colon cancer according to the pathologic report after radical surgery at Samsung Medical Center from May 2005 to June 2007 and who had received capecitabine as adjuvant therapy. The patients were divided into groups according to whether the dose was reduced (I, dose maintenance; II, dose reduction) or stopped (A, cycle completion; B, cycle cessation). Recurrence and disease-free survival rates between the two groups each were analyzed. Results Of the 173 patients, 128 (74.6%) experienced complications, most frequently hand-foot syndrome (n = 114). Reduction (n = 35) or cessation (n = 18) of medication was most commonly due to complications. Concerning reduced dosage, both groups displayed no statistically significant differences in recurrence rate and 3-year disease-free survival rate. Concerning discontinued medication use, the cycle completion group showed an improved recurrence rate (P = 0.048) and 3-year disease-free survival rate (P = 0.028). Conclusion The results demonstrate that maintaining compliance with capecitabine as an adjuvant treatment for colon cancer to preventing complications positively affects patient prognosis.
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Affiliation(s)
- Jung-A Yun
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Best JH, Garrison LP. Economic evaluation of capecitabine as adjuvant or metastatic therapy in colorectal cancer. Expert Rev Pharmacoecon Outcomes Res 2010; 10:103-14. [PMID: 20384557 DOI: 10.1586/erp.10.12] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Capecitabine, an oral prodrug of 5-fluorouracil, is indicated for adjuvant treatment in patients with Dukes' C colon cancer and for subsequent lines in metastatic colorectal cancer. The aim of this article is to review the literature on the economics of capecitabine for the treatment of colon cancer. A systematic review was conducted to search for articles published from January 2003 to December 2009 that met the inclusion criteria. For abstracts that were considered acceptable, full-text articles were then reviewed. Of the 42 potential studies that were identified, 13 original studies (16 publications) met the inclusion criteria. To date, the economic evaluation literature has consistently projected or found that capecitabine is not only a cost-effective treatment for adjuvant or for metastatic colorectal cancer (i.e., providing good value for money) but, furthermore, would actually be cost saving in the majority of country settings.
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Affiliation(s)
- Jennie H Best
- Department of Pharmacy, University of Washington, Box 357630, Seattle, WA 98195, USA.
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Aggarwal BB, Danda D, Gupta S, Gehlot P. Models for prevention and treatment of cancer: problems vs promises. Biochem Pharmacol 2009; 78:1083-94. [PMID: 19481061 PMCID: PMC2748136 DOI: 10.1016/j.bcp.2009.05.027] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 05/16/2009] [Accepted: 05/19/2009] [Indexed: 02/03/2023]
Abstract
Current estimates from the American Cancer Society and from the International Union Against Cancer indicate that 12 million cases of cancer were diagnosed last year, with 7 million deaths worldwide; these numbers are expected to double by 2030 (27 million cases with 17 million deaths). Despite tremendous technological developments in all areas, and President Richard Nixon's initiative in the 1974 "War against Cancer", the US cancer incidence is the highest in the world and the cancer death rate has not significantly changed in the last 50 years (193.9 per 100,000 in 1950 vs 193.4 per 100,000 in 2002). Extensive research during the same time, however, has revealed that cancer is a preventable disease that requires major changes in life style; with one third of all cancers assigned to Tobacco, one third to diet, and remaining one third to the environment. Approximately 20 billion dollars are spent annually to find a cure for cancer. We propose that our inability to find a cure to cancer lies in the models used. Whether cell culture or animal studies, no model has yet been found that can reproduce the pathogenesis of the disease in the laboratory. Mono-targeted therapies, till know in most cases, have done a little to make a difference in cancer treatment. Similarly, molecular signatures/predictors of the diagnosis of the disease and response are also lacking. This review discusses the pros and cons of current cancer models based on cancer genetics, cell culture, animal models, cancer biomarkers/signature, cancer stem cells, cancer cell signaling, targeted therapies, therapeutic targets, clinical trials, cancer prevention, personalized medicine, and off-label uses to find a cure for cancer and demonstrates an urgent need for "out of the box" approaches.
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Affiliation(s)
- Bharat B Aggarwal
- Cytokine Research Laboratory, Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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Maniadakis N, Fragoulakis V, Pectasides D, Fountzilas G. XELOX versus FOLFOX6 as an adjuvant treatment in colorectal cancer: an economic analysis. Curr Med Res Opin 2009; 25:797-805. [PMID: 19215190 DOI: 10.1185/03007990902719117] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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 euro with FOLFOX6 and 9713 euro with XELOX; costs of administration and hospitalisations were 5154 euro and 1050 euro, respectively. Total treatment cost with FOLFOX6 reached 17,480 euro and with XELOX 12 525 euro, a difference of 4955 euro (p < 0.001) in favour of the latter therapy. From an SIF perspective, the total cost of treatment was 16,240 euro with FOLFOX6 and 12,617 euro with XELOX, a reduction of 3623 euro (p < 0.001) with the latter therapy. Mean patient travelling cost was 184 euro with FOLFOX6 and 80 euro with XELOX, a difference of 104 euro (p < 0.001). Mean productivity loss was 100 euro with FOLFOX6 and 31 euro with XELOX, a difference of 69 euro (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.
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Affiliation(s)
- Nikos Maniadakis
- Department of Health Services Organisation and Management, National School of Public Health, Athens, Greece.
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