Patients With Locally Advanced and Metastatic Colorectal Cancer Treated With Capecitabine Versus 5-Fluorouracil as Monotherapy or Combination Therapy With Oxaliplatin: A Cost Comparison

Abstract

This study quantified the costs associated with the acquisition of chemotherapy, its administration, and the management of chemotherapy-related complications, and their effect on total patient expenditures. Patients with locally advanced and metastatic colorectal cancer treated with capecitabine or 5-fluorouracil/leucovorin (5-FU/LV) as monotherapy or combination therapy with oxaliplatin from 2003-2006 were identified in the Thomson Reuters MarketScan® databases. Selection bias between treatment groups was addressed by propensity score matching, assessment of the risk of complications using Cox models, and an estimate of expenditures using general linear models. In respect to monotherapy, capecitabine users (n = 1272) were propensity score matched to 5-FU/LV users on a 1:1 ratio. The adjusted mean monthly cost was significantly lower for patients treated with capecitabine versus 5-FU/LV ($6683 vs. $9304, respectively; P < .0001). Although the cost of drug acquisition was significantly higher for capecitabine than for 5-FU/LV (unadjusted P < .0001), significantly lower costs of capecitabine administration (unadjusted P < .0001) and management of complications (adjusted costs, P < .0001) offset the difference, and drove a lower overall cost. In regard to combination therapy, capecitabine/oxaliplatin users (n = 263) were propensity score matched to 5-FU/LV/oxaliplatin users (n = 526) on a 1:2 ratio. The adjusted mean monthly cost was significantly lower for capecitabine/oxaliplatin than for 5-FU/LV/oxaliplatin ($11,436 vs. $14,320, respectively; P < .0001). The cost difference was driven by the significantly lower administration costs of capecitabine-based chemotherapy (unadjusted P < .0001) and management of complications (adjusted P < .0001). The monthly cost per patient during capecitabine or capecitabine/oxaliplatin treatment is significantly lower than during 5-FU/LV or 5-FU/LV/oxaliplatin treatment because of lower costs for the administration of chemotherapy and for the management of complications.