Patients with locally advanced and metastatic colorectal cancer treated with capecitabine versus 5-fluorouracil as monotherapy or combination therapy with oxaliplatin: A cost comparison

Introduction: 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 and Methods: 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. Results: 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). Conclusion: 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.