Takeru Shiroiwa (Department of Drug Policy and Management, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan) Takashi Fukuda (Department of Health Economics and Epidemiology Research, School of Public Health, The University of Tokyo, Tokyo, Japan) Kojiro Shimozuma (Department of Biomedical Sciences, College of Life Sciences, Ritsumeikan University, Kusatsu, Japan) Yasuo Ohashi (Department of Biostatistics, School of Public Health, The University of Tokyo, Tokyo, Japan) Kiichiro Tsutani (Department of Drug Policy and Management, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan)
Abstract
Objective: A cost-effectiveness analysis of oral capecitabine versus intravenous bolus 5-fluorouracil/l-leucovorin (FU/LV) as adjuvant therapy in patients with stage 3 colon cancer was performed from a Japanese healthcare payer perspective. Methods: Adjuvant therapy comprised 24 weeks of treatment with either oral capecitabine 1250 mg/m twice daily on days 1-14 of a 21-day cycle or intravenous bolus FU 500 mg/m and LV 250 mg/m weekly for 6 weeks of an 8-week cycle (Roswell Park regimen). The analysis comprised short-term (1 year after initiation of adjuvant therapy) and long-term (up to 15 years) components. The long-term analysis involved a three-state (disease-free, recurrence and death) Markov model. Estimates for transition probabilities, costs and utilities were derived from the X-ACT trial, a Japanese phase II trial, and other published sources. Cost estimates were considered from the perspective of a healthcare payer. Costs were expressed in Japanese Yen (¥), year 2007 values. A discount rate of 3% was applied to costs and outcomes. Cost effectiveness was expressed as a cost per QALY. The effects of uncertainty were explored through one-way and probabilistic sensitivity analyses. Results: In the 1-year analysis, direct costs were ¥440 000 ($US4000) less per patient with capecitabine than with FU/LV. In the long-term analysis, differences between treatments in direct medical costs ranged from ¥470 000 ($US4300) to ¥580 000 ($US5300) depending on the time horizon used. Capecitabine was also projected to increase the number of QALYs compared with FU/LV. The sensitivity analysis suggested that the model outcome was robust. The probabilistic sensitivity analysis estimate of capecitabine being the dominant regimen was 96.6% at a zero willingness to pay. Direct costs remained lower with capecitabine if the price of generic LV was ≥50% of the branded product. Conclusion: This analysis suggests that capecitabine improves health outcomes and lowers direct costs compared with bolus FU/LV (i.e. dominant treatment strategy) when used as adjuvant therapy in patients with stage 3 colon cancer in Japan.
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Article provided by Wolters Kluwer Health | Adis in its journal PharmacoEconomics.
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