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Clinical and cost-effectiveness of capecitabine and tegafur with uracil for the treatment of metastatic colorectal cancer: systematic review and economic evaluation

By S. Ward, E. Kaltenthaler, J. Cowan and N. Brewer


Objectives: \ud \ud To evaluate the clinical and costeffectiveness\ud of capecitabine and tegafur with uracil\ud (UFT/LV) as first-line treatments for patients with\ud metastatic colorectal cancer, as compared with 5-\ud fluorouracil/folinic acid (5-FU/FA) regimens.\ud Data sources: Electronic databases, reference lists of\ud relevant articles and sponsor submissions were also\ud consulted.\ud \ud \ud Review methods: \ud \ud Systematic searches, selection\ud against criteria and quality assessment were performed\ud to obtain data from relevant studies. Costs were\ud estimated through resource-use data taken from the\ud published trials and the unpublished sponsor\ud submissions. Unit costs were taken from published\ud sources, where available. An economic evaluation was\ud undertaken to compare the cost-effectiveness of\ud capecitabine and UFT/LV with three intravenous 5-\ud FU/LV regimens widely used in the UK: the Mayo, the\ud modified de Gramont regimen and the inpatient de\ud Gramont regimens.\ud \ud \ud Results: \ud \ud The evidence suggests that treatment with\ud capecitabine improves overall response rates and has\ud an improved adverse effect profile in comparison with\ud 5-FU/LV treatment with the Mayo regimen, with the\ud exception of hand–foot syndrome. Time to disease\ud progression or death after treatment with UFT/LV in\ud one study appears to be shorter than after treatment\ud with 5-FU/LV with the Mayo regimen, although it also\ud had an improved adverse effect profile. Neither\ud capecitabine nor UFT/LV appeared to improve healthrelated\ud quality of life. Little information on patient\ud preference was available for UFT/LV, but there was\ud indicated a strong preference for this over 5-FU/LV.\ud The total cost of capecitabine and UFT/LV treatments\ud were estimated at £2111 and £3375, respectively,\ud compared with the total treatment cost for the Mayo\ud regimen of £3579. Cost estimates were also presented\ud for the modified de Gramont and inpatient de Gramont\ud regimens. These were £3684 and £6155, respectively.\ud No survival advantage was shown in the RCTs of the\ud oral drugs against the Mayo regimen. Cost savings of\ud capecitabine and UFT/LV over the Mayo regimen were\ud estimated to be £1461 and £209, respectively. Drug\ud acquisition costs were higher for the oral therapies\ud than for the Mayo regimen, but were offset by lower\ud administration costs. Adverse event treatment costs\ud were similar across the three regimens. It was inferred\ud that there was no survival difference between the oral\ud drugs and the de Gramont regimens. Cost savings of\ud capecitabine and UFT/LV over the modified de\ud Gramont regimen were estimated to be £1353 and\ud £101, respectively, and over the inpatient de Gramont\ud regimen were estimated to be £4123 and £2870,\ud respectively.\ud \ud Conclusions:\ud \ud The results show that there are cost\ud savings associated with the use of oral therapies. No\ud survival difference has been proven between the oral\ud drugs and the Mayo regimen. In addition, no evidence\ud of a survival difference between the Mayo regimen and\ud the de Gramont regimens has been identified.\ud However, improved progression-free survival and an\ud improved adverse event profile have been shown for\ud the de Gramont regimen over the Mayo regimen.\ud Further research is recommended into the following\ud areas: quality of life data should be included in trials of\ud colorectal cancer treatments; the place of effective oral\ud treatments in the treatment of colorectal cancer, the\ud safety mechanisms needed to ensure compliance and\ud the monitoring of adverse effects; the optimum\ud duration of treatment; the measurement of patient\ud preference; and a phase III comparative trial of\ud capecitabine and UFT/LV versus modified de Gramont\ud treatment to determine whether there was any survival\ud advantage and to collate the necessary economic data

Publisher: Gray Publishing
Year: 2003
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