Cost-minimization analysis (CMA) of capecitabine plus oxaliplatin (XELOX) compared with modified FOLFOX6 (mFOLFOX6) for the adjuvant treatment of resected colon cancer in British Columbia.

Abstract

e16538 Background: Evidence suggests that XELOX (NO16968 XELOXA) may have similar efficacy as mFOLFOX6 in the adjuvant treatment of colon cancer. Because XELOX is partly administered orally and is associated with a 3-week rather than a 2-week treatment cycle, we conducted a CMA from the healthcare payer and societal perspectives in order to evaluate the potential cost savings of replacing mFOLFOX6 with XELOX in the province of British Columbia, Canada. Methods: Applying treatment and toxicity data from phase III clinical trials of XELOX and FOLFOX-based regimens to the adjuvant colon cancer population in British Columbia, the CMA compared total costs associated with chemotherapy medications, drug administration and delivery, hospital and clinic visits, treatment-related toxicities, and need for central venous access devices (CVADs). Costs to patients in terms of lost time and decreased travel were also considered. We assumed that patients would receive either 8 cycles of XELOX or 12 cycles of mFOLFOX6 in our cost models. Results: The different costs by type are summarized in the table. From the payer perspective, the use of XELOX resulted in cost savings of $5,339 per patient when compared to mFOLFOX6. From a societal perspective, XELOX was also associated with savings of $6,082 per patient. The greatest cost savings with XELOX were attributed to fewer visits for chemotherapy treatment and decreased CVAD usage. XELOX was also associated with less loss of time and decreased travel for patients because of fewer clinic visits. Conclusions: Replacing mFOLFOX6 with XELOX in the adjuvant treatment of colon cancer may be associated with potential cost savings from both the payer and societal perspectives. Cost items (all in CAD currency) XELOX mFOLFOX6 Incremental difference Drug costs $24,280 $25,399 Administration costs $1,647 $3,302 Hospitalization costs $2,172 $3,163 Clinic costs $107 $121 Toxicity costs $82 $78 Central venous access costs $194 $1,757 Total costs - payer $28,484 $33,823 - $5,339 Patient time costs $2,745 $3,257 Patient travel costs $1,116 $1,345 Total costs - societal $32,345 $38,427 - $6,082