Pharmacoeconomic analysis of capecitabine for advanced gastric cancer in Taiwan

Abstract

15576 Background: Capecitabine combined with cisplatin (XP) is a safe and effective alternative to intravenous 5-fluorouracil plus cisplatin (FP) in previously untreated patients with advanced and metastatic gastric cancer (AGC). The objective of this pharmacoeconomic analysis was to access the cost-effectiveness of XP versus FP for AGC treatment from Taiwan societal perspective. Methods: A cost-minimization analysis was undertaken by applying clinical outcomes and medical resource utilization (MRU) retrieved from phase III ML17032 study. Direct medical costs associated with trial-based MRU were based on Taiwan's National Health Insurance fee schedule for 2007. Costs associated with intravenous chemotherapy administration and adverse event (AE) management were estimated by an expert panel survey conducted among 12 oncologists. From a societal perspective, direct non-medical and indirect costs borne by patients, such as travel and time costs, were also considered. One-way sensitivity analyses were performed on key model parameters by varying the input values by ± 10%. Results: A trend toward superior progression-free survival was observed in XP arm (median 5.6 months for XP versus 5.0 for FP). Compared to FP, administration of XP required fewer consults per patient (5.2 for XP versus 22.8 for FP). Chemotherapy drug cost was higher (USD$1,712) in the XP arm; however, these cost increments were offset by differences of chemotherapy administration costs (USD$4,376) between two arms. AE profiles were similar and the costs associated with grade 3/4 AE management were slightly lower (USD$30) in the XP arm. Taking into account direct medical costs (chemotherapy administration and AE management), direct non- medical cost (travel), and indirect cost (time), XP was associated with a significant cost saving of USD$5,310 (NTD$172,197). XP remained cost-saving under one-way sensitivity analyses. Conclusions: Given the trend to superior efficacy, the significant cost savings, and the convenience of oral treatment, XP would be a dominant (less costly and more effective) regimen for AGC from the Taiwan societal perspective. Replacing FP by XP would not only reduce health care expenditures but also improve health outcomes in Taiwan. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration F. Hoffmann-La Roche AG, Roche Taiwan