title: Cost minimization analysis of capecitabine versus 5-fluorouracil-based treatment for gastric cancer patients in Hong Kong.
abstract: BACKGROUND
  EOX (epirubicin, oxaliplatin, Xeloda; capecitabine) and FOLFOX4 (5-fluorouracil (5-FU), leucovorin, oxaliplatin) are the common chemotherapy regimens used in the treatment of advanced gastric cancer (aGC) in Hong Kong. This study aimed to compare the costs of these therapies for aGC patients from both the healthcare and societal perspectives. It should be noted that, while FOLFOX4 is routinely administered in an outpatient setting in North America and Europe, inpatient setting is adopted in Hong Kong instead, incurring hospitalization cost as a result.
  
  
  METHODS
  Fifty-eight patients were identified from the electronic records in two public tertiary hospitals, with 45 and 13 receiving EOX and FOLFOX4 regimens, respectively. Healthcare cost was direct medical costs including drugs, clinic follow-up, hospitalization, diagnostic laboratories, and radiographs. Societal cost refers to indirect costs such as patient time and travel costs. Cost items were further classified as "expected" or "unexpected". All cost data was expressed in US dollars.
  
  
  RESULTS
  Patients in the EOX and FOLFOX4 arm received an average of 5.3 and 7.8 cycles of treatment, respectively. The capecitabine-based regimen group had a higher expected medication cost per cycle when compared to the 5-FU-based treatment group (US$290.3 vs US$66.9, p < .001), but lower expected hospitalization costs (US$76.9 vs US$1,269.2, p < .001). The total healthcare cost and total societal cost per patient was reduced by 67.2% (US$5,691.9 vs US$17,357.4, p < .001) and 25.3% (US$3,090.5 vs US$4,135.1, p = .001), respectively, in the capecitabine-based regimen group. Sensitivity analyses based on full cycle regimen costs and net capecitabine or 5-FU/leucovorin costs still showed EOX to be less costly than FOLFOX4.
  
  
  CONCLUSIONS
  The capecitabine-based regimen, EOX, was found to generate significant cost saving from both the healthcare and societal perspectives in regions in which FOLFOX4 is given in an inpatient setting.
authors.affiliation: a School of Pharmacy , The Chinese University of Hong Kong , Shatin , PR China.
authors.forename: Keary R
authors.initials: KR
authors.lastname: Zhou
authors.affiliation: b Department of Oncology , Pamela Youde Nethersole Eastern Hospital , Chai Wan , PR China.
authors.forename: Ashley
authors.initials: A
authors.lastname: Cheng
authors.affiliation: c Department of Oncology , Princess Margaret Hospital , Kwai Chung , PR China.
authors.forename: W T
authors.initials: WT
authors.lastname: Ng
authors.affiliation: a School of Pharmacy , The Chinese University of Hong Kong , Shatin , PR China.
authors.forename: T Y
authors.initials: TY
authors.lastname: Kwok
authors.affiliation: d Department of Pharmacy , Princess Margaret Hospital , Kwai Chung , PR China.
authors.forename: Elton Y P
authors.initials: EY
authors.lastname: Yip
authors.affiliation: d Department of Pharmacy , Princess Margaret Hospital , Kwai Chung , PR China.
authors.forename: Rosa
authors.initials: R
authors.lastname: Yao
authors.affiliation: e Department of Pharmacy , Pamela Youde Nethersole Eastern Hospital , Chai Wan , PR China.
authors.forename: P Y
authors.initials: PY
authors.lastname: Leung
authors.affiliation: a School of Pharmacy , The Chinese University of Hong Kong , Shatin , PR China.
authors.forename: V W Y
authors.initials: VW
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D000069287:Capecitabine / Q000191:economics* / Q000627:therapeutic use; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005260:Female; D005472:Fluorouracil / Q000191:economics* / Q000627:therapeutic use; D005102:Health Expenditures / Q000706:statistics & numerical data; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006723:Hong Kong; D006801:Humans; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy*
chemical_list: D000069287:Capecitabine; D005472:Fluorouracil
keywords: 5-Fluorouracil based treatment; Capecitabine; Cost minimization analysis; Gastric cancer