title: Costs of treatment of colorectal cancer in different settings in Germany.
abstract: The objective of this study was to evaluate the cost implications of different settings (inpatient, outpatient/day clinic, or office-based oncologists) for the administration of standard fluoropyrimidine therapies, i.e., Mayo Clinic and Arbeitsgemeinschaft Internistische Onkologie (AIO)/Ardalan regimen, and to compare the results with the cost of oral capecitabine in Germany. In total, 89 quarterly fee-listings from 26 patients provided by 5 office-based oncologists were analyzed. Physician's services, drug costs, pharmacy costs, and costs for implantable venous port systems and single-use pumps were considered. Findings were transferred to the hospital setting. A third-party payer perspective was applied. Quarterly treatment costs for the Mayo Clinic regimen varied between <euro> 2,036 and <euro> 10,569, and between <euro> 1,294 and <euro> 10,179 for the AIO/Ardalan regimen depending on the treatment setting. Projected costs for capecitabine were <euro> 2,338. No hospitalization was considered to be necessary for capecitabine due to its oral administration route. The most expensive treatment options were the AIO/Ardalan protocol in the office-based setting and the Mayo Clinic protocol in the hospital setting. Capecitabine emerged as the cheapest option in the office-based setting. Overall, the cheapest option was the AIO/Ardalan protocol in municipal hospitals. However, municipal hospitals are unlikely to cover their costs in this situation. Substantial cost savings without incurring losses to providers may be realized if patients are transferred from the hospital setting to the office-based setting and treated with capecitabine.
authors.affiliation: NEOS Health, Parkstrasse 28, 4102, Binningen, Switzerland. klaus.hieke@neoshealth.com
authors.forename: Klaus
authors.initials: K
authors.lastname: Hieke
authors.forename: Ulrich R
authors.initials: UR
authors.lastname: Kleeberg
authors.forename: Martina
authors.initials: M
authors.lastname: Stauch
authors.forename: Axel
authors.initials: A
authors.lastname: Grothey
mesh_terms: D000284:Administration, Oral; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D000069287:Capecitabine; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000191:economics*; D003365:Costs and Cost Analysis; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics* / Q000627:therapeutic use; D005472:Fluorouracil / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D005858:Germany; D006773:Hospitals, Municipal; D006785:Hospitals, University; D006801:Humans; D007297:Inpatients; D002955:Leucovorin / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D010045:Outpatients; D013997:Time Factors
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000069287:Capecitabine; D002955:Leucovorin; D005472:Fluorouracil
references.citation: J Clin Oncol. 1997 Jan;15(1):110-5
references.pmid: 8996131
references.citation: BMJ. 2001 Jan 6;322(7277):1-2
references.pmid: 11141128
references.citation: Br J Cancer. 2000 Jun;82(11):1789-94
references.pmid: 10839292
references.citation: Value Health. 2003 Mar-Apr;6(2):167-74
references.pmid: 12641867
references.citation: Ann Oncol. 2002 Apr;13(4):566-75
references.pmid: 12056707
references.citation: Med Klin (Munich). 2002 May 15;97(5):270-7
references.pmid: 12078387
references.citation: Haematologica. 2002 Jul;87(7):719-29; discussion 729
references.pmid: 12091123
references.citation: Eur J Cancer. 2002 Feb;38 Suppl 2:15-20
references.pmid: 11841931
references.citation: Eur J Cancer. 2001 Mar;37(5):597-604
references.pmid: 11290435