title: Out-of-pocket payment and cost-effectiveness of XELOX and XELOX plus bevacizumab therapy: from the perspective of metastatic colorectal cancer patients in Japan.
abstract: OBJECTIVE
  The purpose of our study was to estimate the out-of-pocket payment and cost-effectiveness of capecitabine plus oxaliplatin (XELOX) or XELOX plus bevacizumab from the perspective of patients with metastatic colorectal cancer (MCRC).
  
  
  METHODS
  Based on the NO16966 and NO16967 trials, the mean out-of-pocket payment was calculated from patient-level data. Out-of-pocket payments for 16 cycles (11 months) of first-line chemotherapy and 8 cycles (5 months) of second-line chemotherapy were included. In addition, incremental cost-effectiveness ratios (ICERs) for first-line bevacizumab were calculated by dividing the difference of the out-of-pocket payment by the difference of the mean number of progression-free survival (PFS) years or quality-adjusted PFS (QAPFS) years.
  
  
  RESULTS
  The mean out-of-pocket payments for middle-income patients under 70 years of age were JPY 328,000 for 16 cycles of first-line XELOX and JPY 376,000 for XELOX plus bevacizumab. The mean out-of-pocket payment for 8 cycles of second-line XELOX was calculated to be JPY 175,000. Middle-income patients over 70 years of age were required to pay JPY 61,000 and JPY 72,000 for first-line XELOX and XELOX plus bevacizumab, respectively. The ICERs of middle-income patients <70 years of age were JPY 430,000/PFS-year and JPY 720,000/QAPFS-year, and those of middle-income patients >70 years of age were JPY 100,000/PFS-year and JPY 170,000/QAPFS-year.
  
  
  CONCLUSIONS
  We clarified the out-of-pocket payment and cost-effectiveness of chemotherapy of MCRC patients in Japan. Our previous survey shows it is highly possible that many patients prefer to pay that incremental out-of-pocket payment to gain one additional QAPFS year. However, our cost-effectiveness analysis was not conducted from the perspective of society or healthcare payers.
authors.affiliation: Department of Drug Policy and Management, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Yakugaku-toshokan 4F, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. t.shiroiwa@gmail.com
authors.forename: Takeru
authors.initials: T
authors.lastname: Shiroiwa
authors.forename: Takashi
authors.initials: T
authors.lastname: Fukuda
authors.forename: Kiichiro
authors.initials: K
authors.lastname: Tsutani
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000191:economics*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000191:economics*; D061067:Antibodies, Monoclonal, Humanized; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000191:economics*; D000068258:Bevacizumab; D000069287:Capecitabine; D017326:Clinical Trials, Phase III as Topic; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000401:mortality / Q000556:secondary; D017047:Cost Sharing; D003362:Cost-Benefit Analysis; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics; D018572:Disease-Free Survival; D016527:Drug Costs; D005382:Financing, Personal; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics; D006801:Humans; D007564:Japan; D015337:Multicenter Studies as Topic; D010071:Oxaloacetates; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D010071:Oxaloacetates; D003841:Deoxycytidine; D000068258:Bevacizumab; D000069287:Capecitabine; D005472:Fluorouracil