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

Abstract

Two oral fluoropyrimidine therapies have been introduced for metastatic colorectal cancer. One is a 5-fluorouracil pro-drug, capecitabine; the other is a combination of tegafur and uracil administered together with leucovorin. The purpose of this study was to compare the clinical effectiveness and cost-effectiveness of these oral therapies against standard intravenous 5-fluorouracil regimens. A systematic literature review was conducted to assess the clinical effectiveness of the therapies and costs were calculated from the UK National Health Service perspective for drug acquisition, drug administration, and the treatment of adverse events. A costminimisation analysis was used; this assumes that the treatments are of equal efficacy, although direct randomised controlled trial (RCT) comparisons of the oral therapies with infusional 5-fluorouracil schedules were not available. The cost-minimisation analysis showed that treatment costs for a 12-week course of capecitabine (d2132) and tegafur with uracil (d3385) were lower than costs for the intravenous Mayo regimen (d3593) and infusional regimens on the de Gramont (d6255) and Modified de Gramont (d3485) schedules over the same treatment period. Oral therapies result in lower costs to the health service than intravenous therapies. Further research is needed to determine the relative clinical effectiveness of oral therapies vs infusional regimens.

Randomised trial comparing biweekly oxaliplatin plus oral capecitabine versus oxaliplatin plus i.v. bolus fluorouracil/leucovorin in metastatic colorectal cancer patients: results of the Southern Italy Cooperative Oncology study 0401

“…Moreover, some studies have shown that capecitabine is associated with reduced costs compared with i.v. Xuorouracil/leucovorin in both the adjuvant and palliative setting (Cassidy et al 2006;Ward et al 2006), and that the majority of cost savings were due to the reduced administration costs. The additional cost of combining oxaliplatin with capecitabine instead of Xuorouracil/leucovorin (Mayer 2007) could be counterbalanced by the lower incidence of some lifethreatening adverse events, translating into reduced costs for hospitalization.…”

Capecitabine and Radiotherapy as Neoadjuvant Treatment for Rectal Cancer

“…31 The treatment costs for a 12-week course of capecitabine (£2132) were found to be lower than those for the tegafur/ uracil combination (£3385), the intravenous Mayo regimen (£3593), and infusional regimens on the de Gramont (£6255) and Modified de Gramont (£3485) schedules over the same treatment period. Thus, assuming equivalent efficacy (cost minimization analysis), the study supported a cost-effectiveness argument in favor of oral therapies such as capecitabine over intravenous treatments.…”

Polymeric Nanoparticle Technologies for Oral Drug Delivery

“…Oral formulations also have advantages for physicians, providing flexibility and adaptability to tune the dosing schedule to individual patients responses based on efficacy and toxicity. Without the intensive demands on staff required by intravenous administrations, oral formulations can also increase the number of patients treated 59 and reductions in the number of hospital or clinic visits could reduce overall costs 60–63 .…”