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Capecitabine/Oxaliplatin Combination Reduces Treatment Costs in Metastatic Colorectal Cancer

Capecitabine/Oxaliplatin Combination Reduces Treatment Costs in Metastatic Colorectal Cancer

NEW HAVEN, Connecticut- An economic analysis comparing the cost of treating metastatic colorectal cancer with capecitabine (Xeloda) and oxaliplatin (Eloxatin) in combination (XELOX) vs the cost of using fluorouracil (5-FU), leucovorin, oxaliplatin (FOLFOX4) demonstrated a $4,613 per patient cost savings with XELOX over a 6-month treatment period. The results of the cost analysis were reported by Edward Chu, MD, professor of medicine and pharmacology, Yale University School of Medicine, New Haven, Connecticut (ASCO abstract 1080). Two categories of direct costs were considered. The first category, chemotherapy acquisition plus administration costs per patient, was $42,037 for XELOX vs $44,607 for FOLFOX4. The increased drug acquisition cost for XELOX ($41,144) compared with FOLFOX4 ($34,616) was more than offset by the large reduction in the drug administration cost for XELOX ($893) compared with FOLFOX4 ($9,991). This resulted in a net reduction in the cost of treatment administration of $2,570. Fewer Adverse Events For the second category, management of adverse events, investigators determined that treatment-related adverse events requiring medical intervention are twice as likely with FOLFOX4 compared with XELOX (probability of treatment requirement: 1.188 vs 0.540). The cost of managing adverse events is therefore substantially reduced for XELOX compared with FOLFOX4 ($405 vs $2,448) for a cost reduction of $2,043 per patient. This difference is primarily driven by the higher rate of neutropenia observed with FOLFOX4. Results of a large phase II trial using XELOX to treat metastatic colorectal cancer demonstrated a 55% response rate and favorable safety data, with 7.6 months progression- free survival and 19.5 months overall survival. These results are generally comparable to the therapeutic profile of FOLFOX, but the XELOX regimen has an added advantage of convenience, requiring fewer days of hospitalization or clinic time for IV infusions. "The oral administration of capecitabine enables chronic twice-daily dosing that closely mimics continuous infusion 5-FU. In the studies performed to date, the combination of capecitabine and oxaliplatin (XELOX) is at least as effective as FOLFOX4 (oxaliplatin/5-FU/leucovorin) and has a favorable safety profile," Dr. Chu said. Most importantly, XELOX offers improved convenience over FOLFOX4 because the FOLFOX4 regimen requires bimonthly treatments. In contrast, the XELOX regimen requires only a brief hospital visit once every 3 weeks. "The cost benefit of XELOX would add to any gains in patient satisfaction due to its oral convenience, favorable safety profile, and/or indirect cost savings due to the extra clinic/travel time patients require for FOLFOX." Dr. Chu concluded. These projections are being further tested in ongoing randomized trials.

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