OBJECTIVES: Colorectal cancer is the second most commonlydiagnosed cancer and the third cause of cancer-related mortalityin Taiwan. Capecitabine, an oral fluoropyrimidine, is an effec-tive alternative to intravenous fluorouracil plus leucovorin (5-FU/LV) in adjuvant treatment of stage III colon cancer. Theobjective of this pharmacoeconomic analysis is to access the cost-effectiveness of capecitabine compared to 5-FU/LV in the adju-vant setting in Taiwan from the payer’s [Bureau of NationalHealth Insurance (BNHI)] perspective. METHODS: A state-transition economic model was developed to estimate incremen-tal cost impact and the effectiveness in terms of quality-adjustedlife months (QALMs). Clinical outcomes and medical resourceutilization were collected during the phase III X-ACT study.Direct medical costs associated with chemotherapy drugs, physi-cian consultations, and adverse events (AEs) management werebased on Taiwan’s National Health Insurance fee schedule. Intra-venous chemotherapy administration costs and post-treatmentcosts were estimated from an expert panel survey conductedamong 12 colorectal surgeons and medical oncologists. Health-related utility scores were obtained from published literature.Outcomes and future costs were discounted at 1.5% and 6%respectively. Sensitivity analyses were performed on key modelparameters. RESULTS: Administration of capecitabine requiredfewer physician visits per patient (7.4 versus 28.0 with 5-FU/LV).Drug acquisition costs of capecitabine were higher than 5-FU/LV,however, these cost increments were offset by the chemotherapyadministration cost of 5-FU/LV. In addition, more expensivemedications and longer hospitalization were needed to manage5-FU/LV-related AEs. As a result, capecitabine demonstrated asignificant overall cost savings of $104,546 NTD. Over a life-time, the survival benefit for capecitabine extends to 9 QALMs.Capecitabine remained dominant under sensitivity testing. CON-CLUSION: From a Taiwan BNHI perspective, this pharma-coeconomic analysis showed that the use of capecitabine inadjuvant treatment of colon cancer would not only save directmedical costs but also improve health outcomes compared to 5-FU/LV.
