title: Pharmaco-economic analysis of direct medical costs of metastatic colorectal cancer therapy with XELOX or modified FOLFOX-6 regimens: implications for health-care utilization in Australia.
abstract: OBJECTIVE
  The objective of this economic evaluation, which was based on patients from two randomized controlled clinical trials (NO16966 and NO16967), was to compare direct medical costs to the Australian health-care system of capecitabine plus oxaliplatin (XELOX) and bolus and/or infusional 5-fluorouracil (5-FU) plus folinic acid combined with oxaliplatin (modified [m] FOLFOX-6) in first-line and second-line treatment of advanced or metastatic colorectal cancer (mCRC).
  
  
  METHODS
  Direct medical costs were estimated for five treatment settings from a public and private hospital. The costs included in evaluation were for drug acquisition, preparation (oxaliplatin, bolus and infusional 5-FU), administration and wastage. The cost of drug acquisition was calculated based on dosage data and the mean number of treatment cycles from the pivotal studies NO16966 and NO16967. There were no costs associated with preparing capecitabine and leucovorin. An oncology grouping and costing study was performed to determine the relevant administration costs associated with central venous access devices, their placement, maintenance and removal (for oxaliplatin administration) and the continuous infusion of 5-FU via a continuous ambulatory delivery device pump or infuser.
  
  
  RESULTS
  This economic evaluation has shown that treating mCRC patients with XELOX in the first and second-line settings results in average cost savings of $9110 and $7113, respectively, compared with mFOLFOX-6. A multi-way sensitivity analysis demonstrated that the use of XELOX remained cost-saving from an Australian government health budget perspective.
  
  
  CONCLUSIONS
  The use of XELOX, compared with mFOLFOX-6, for the treatment of mCRC is cost-saving in the Australian government health budget.
authors.affiliation: Roche Products Pty Ltd, New South Wales, Australia. giao.tran@roche.com
authors.forename: Giao
authors.initials: G
authors.lastname: Tran
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Hack
authors.forename: Annette
authors.initials: A
authors.lastname: Kerr
authors.forename: Leanne
authors.initials: L
authors.lastname: Stokes
authors.forename: Peter
authors.initials: P
authors.lastname: Gibbs
authors.forename: Timothy
authors.initials: T
authors.lastname: Price
authors.forename: Carlene
authors.initials: C
authors.lastname: Todd
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D001315:Australia; D000069287:Capecitabine; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000473:pathology; D003362:Cost-Benefit Analysis; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage / Q000191:economics; D008297:Male; D009362:Neoplasm Metastasis; D009944:Organoplatinum Compounds / Q000008:administration & dosage / Q000191:economics; D010071:Oxaloacetates; D016032:Randomized Controlled Trials as Topic / Q000191:economics
chemical_list: D009944:Organoplatinum Compounds; D010071:Oxaloacetates; D003841:Deoxycytidine; D000069287:Capecitabine; D002955:Leucovorin; D005472:Fluorouracil
keywords: FOLFOX-6; XELOX; metastatic colorectal cancer; pharmaco-economic