Clinical and economic benefits of irinotecan in combination with 5-fluorouracil and folinic acid as first line treatment of metastatic colorectal cancer

Abstract

The combination of irinotecan plus 5-fluorouracil and folinic acid has clinical and survival benefits over 5-fluorouracil and folinic acid alone in the setting of first line treatment of metastatic colorectal cancer. The aim of this cost-effectiveness analysis was to compare the economic implications, from a UK health commissioner perspective, of the two treatment arms (de Gramont regimen) in this setting. Resource utilisation data collected prospectively during the study were used as a basis for estimating cumulative drug dosage, chemotherapy admistration, and treatment of complications during first line therapy. Resource utilisation associated with further chemotherapy in patients who had progressed during the study was derived from a retrospective case note review. Drug acquisition costs were derived from the British National Formulary (September, 2001) and unit costs for clinical consultation and services were taken from the latest relevant cost database. Cumulative costs per patient associated with further chemotherapy were lower in the irinotecan plus 5-fluorouracil and folinic acid treatment arm. Based on incremental costs per life-year gained of £14 794, the combination of irinotecan plus 5-fluorouracil and folinic acid can be considered cost-effective by commonly accepted criteria compared with 5-fluorouracil and folinic acid alone. Thus, clinical and economic data demonstrate that irinotecan, either in combination with irinotecan plus 5-fluorouracil and folinic acid in the first line setting or as monotherapy in the second line setting, has a major role in the management of metastatic colorectal cancer.

Economic impact of simplified de Gramont regimen in first-line therapy in metastatic colorectal cancer

“…Several studies have stressed the major impact of chemotherapy infusion costs among the total palliative treatment costs. In particular, the major impact of the continuous 5-FU infusion costs has been established [9,15,24,28,32]. This 5-FU infusion cost has supported the favorable trends reported by recent economic studies for the use of raltitrexed, capecitabine, and tegafur [15,16,19,24,32].…”

“…Several studies have assessed the economic impact of these new drugs in colorectal cancer management [35]. The economic profile of irinotecan has been judged as an acceptable option in first-and second-line therapy [9,18,22]. Knowing that hospital admission is the major cost pattern in managing advanced colorectal cancer, an interesting option to optimize the cost of treatment can be based on the analysis of chemotherapy schedules [4,26].…”

The clinical and economic benefits of capecitabine and tegafur with uracil in metastatic colorectal cancer

“…In the UK, palliative chemotherapy is offered to an increasing number of patients with metastatic colorectal disease (Cunningham et al, 2002). Various regimens are used in the treatment of metastatic colorectal cancer.…”

Advanced Colorectal Cancer: Current Treatment and Nursing Management With Economic Considerations

“…Another study looked at the clinical and economic benefi ts of irinotecan in combination with 5-FU and folinic acid as the fi rstline treatment for metastatic colorectal cancer (Cunningham, Falk, & Jackson, 2002). Each group had two possible chemotherapy-delivery regimens, although the drugs remained 5-FU with LV in treatment arm B, and irinotecan with 5-FU and LV in arm A.…”