Costs associated with capecitabine or 5-fluorouracil monotherapy after surgical resection in patients with colorectal cancer

Objective: To compare chemotherapy-related and total medical costs among patients with colorectal cancer (CRC) receiving capecitabine or 5-fluorouracil (5-FU) monotherapy after surgical resection. Methods: This retrospective, claim-based study utilized the Thomson Reuters Market Scan® databases to identify 1,396 CRC patients who received capecitabine or 5-FU monotherapy within 90 days of surgical resection from 2003 through 2006. Propensity score matching addressed selection bias, and multivariate models estimated adjusted relative risks of treatment-related complications and medical costs of matched cohorts. Results: Capecitabine users incurred USD 740 less in total direct medical costs (p = 0.003) and USD 785 less in chemotherapy-related costs (p < 0.0001) than 5-FU users. Although drug acquisition cost was higher for capecitabine than for 5-FU (USD 958 vs. USD 71, p < 0.0001), chemotherapy administration cost was lower (USD 76 vs. USD 1,062, p < 0.0001). The unadjusted (610 vs. 1,960 events per 1,000 person-months) and adjusted risks (47%) were lower for capecitabine than 5-FU for any complication, and specifically for bone marrow (67%), gastrointestinal (50%), and constitutional (41%) complications (p < 0.0001, all comparisons). Conclusions: Adjuvant capecitabine monotherapy was associated with lower total medical and chemotherapy-related costs than 5-FU. Reduced complications and costs associated with capecitabine administration offset the higher acquisition cost.