title: Cost impact of oral capecitabine compared to intravenous taxane-based chemotherapy in first-line metastatic breast cancer.
abstract: OBJECTIVE
  Few studies have examined the costs associated with differing first-line chemotherapy regimens in patients with metastatic breast cancer (MBC). This study compares the relative cost impact of women starting first-line chemotherapy with capecitabine versus taxanes.
  
  
  METHODS
  Women receiving first-line chemotherapy for MBC from 1998 to 2002 were identified from a hybrid North Carolina Medicaid-claims-tumour registry linked database and Medicare records, and were followed through to 2005 with claims data. Statistical t- and chi-square tests were used to compare baseline characteristics between patients who received first-line chemotherapy with capecitabine versus taxanes. Projected mean costs for 12 months continuous eligibility were estimated using an ordinary least squares linear regression. Overall cost impact of capecitabine after start of therapy was then examined using a multivariate log-linear regression model.
  
  
  RESULTS
  While patients starting taxanes had significantly lower total costs in the pre-index year than patients starting capecitabine (mean: $20,042 vs. $35,538, p<0.001), in the post-index year, the patients on taxanes experienced significantly higher healthcare utilisation and associated costs compared to patients on capecitabine (mean: $43,353 vs. $35,842, p=0.0089). The differences were primarily attributable to lower expenses in chemotherapy related claims and fewer visit days to outpatient settings for patients on capecitabine. After adjustment with propensity scores and other confounders, the capecitabine group was associated with 32% lower healthcare costs compared to the taxane group (p=0.0001).
  
  
  CONCLUSIONS
  In this population-based study, women who received capecitabine as first-line treatment for MBC had significantly lower costs compared to women starting taxane therapy.
authors.affiliation: Department of Health Evaluation Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA.
authors.forename: Fabian T
authors.initials: FT
authors.lastname: Camacho
authors.forename: Jun
authors.initials: J
authors.lastname: Wu
authors.forename: Wenhui
authors.initials: W
authors.lastname: Wei
authors.forename: Gretchen
authors.initials: G
authors.lastname: Kimmick
authors.forename: Roger T
authors.initials: RT
authors.lastname: Anderson
authors.forename: Rajesh
authors.initials: R
authors.lastname: Balkrishnan
mesh_terms: D000284:Administration, Oral; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000191:economics; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000191:economics*; D000069287:Capecitabine; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics; D016527:Drug Costs; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics; D006801:Humans; D007262:Infusions, Intravenous; D016014:Linear Models; D008875:Middle Aged; D018426:SEER Program; D043823:Taxoids / Q000008:administration & dosage / Q000191:economics*
chemical_list: D000964:Antimetabolites, Antineoplastic; D043823:Taxoids; D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil