1. ¹Cancer Research UK, Department of Medical Oncology, University of Glasgow, Garscube Estate, Bearsden, Glasgow G61 1DB, UK
2. ²Centre René Gauducheau, Site Hospitalier Nord, Bld J Monod, 44805 Saint Herblain, Nantes, France
3. ³Tom Connors Cancer Research Centre, University of Bradford, Richmond Road, Bradford BD7 1DP, UK
4. ⁴Department of Oncology, Box Hill Hospital, Nelson Road, Melbourne, Victoria, Australia
5. ⁵Medizinische Universität Wien, Univ. Klinik für Innere Medizin I, Währinger Gürtel 18–20, A-1090 Vienna, Austria
6. ⁶Nemocnice Ceske Budejovice, Klinika Onkolgie, Bozeny Nemcove 54, 370 87 C Budejovice, Czech Republic
7. ⁷Department of Oncology, Centre for Cancer Research, Queen's University Belfast, Belfast BT9 7AB, UK
8. ⁸PCK Maritime Hospital, Medical Oncology and Radiotherapy Department, ul Powstania Styczniowego 1, 81–519 Gdynia, Poland
9. ⁹Institute for Oncology and Radiology of Serbia, Pasterova 14, 11000 Belgrade, Serbia and Montenegro
10. ¹⁰Department of Medical Oncology, Papageorgiou Hospital, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
11. ¹¹Northern Centre for Cancer Treatment, Newcastle General Hospital, Westgate Road, Newcastle-upon-Tyne NE4 6BE, UK
12. ¹²Hospital Universitario San Carlos, Plaza Cristo Rey S/N, Madrid 28040, Spain
13. ¹³Velindre Hospital, Whitchurch, Cardiff CF4 7XL, UK
14. ¹⁴Clinica de Oncologia Medica S/C Ltda., Av. Nove de Julho, 4644, Sao Paulo 01406-100, Brazil
15. ¹⁵COES, Ospedale S Giovanni Battista sede Molinette, Corso Bramante, 88, 12126 Torino, Italy
16. ¹⁶Klinik und Poliklinik für Chirurgie Klinikum der Universität Regensberg, Franz-Josef Strauss Allee 11, 93053 Regensberg, Germany
17. ¹⁷Oncology Institute, the Elias Sourasky Medical Center, Tel-Aviv 64239, Israel
18. ¹⁸Centre de Lutte Contre le Cancer Paul-Strauss, 3 rue de la Porte de l'Hôpital, F-67065 Strasbourg, France
19. ¹⁹Hoffmann-La Roche Inc., Nutley, NJ, USA
20. ²⁰Roche UK, Welwyn Garden City, UK
21. ²¹University of Washington, Seattle, Washington 98195-7630, USA

Correspondence: Professor J Cassidy, E-mail: j.cassidy@beatson.gla.ac.uk

Received 4 November 2005; Revised 23 February 2006; Accepted 27 February 2006.

Abstract

Oral capecitabine (Xeloda^®) is an effective drug with favourable safety in adjuvant and metastatic colorectal cancer. Oxaliplatin-based therapy is becoming standard for Dukes' C colon cancer in patients suitable for combination therapy, but is not yet approved by the UK National Institute for Health and Clinical Excellence (NICE) in the adjuvant setting. Adjuvant capecitabine is at least as effective as 5-fluorouracil/leucovorin (5-FU/LV), with significant superiority in relapse-free survival and a trend towards improved disease-free and overall survival. We assessed the cost-effectiveness of adjuvant capecitabine from payer (UK National Health Service (NHS)) and societal perspectives. We used clinical trial data and published sources to estimate incremental direct and societal costs and gains in quality-adjusted life months (QALMs). Acquisition costs were higher for capecitabine than 5-FU/LV, but higher 5-FU/LV administration costs resulted in 57% lower chemotherapy costs for capecitabine. Capecitabine vs 5-FU/LV-associated adverse events required fewer medications and hospitalisations (cost savings £3653). Societal costs, including patient travel/time costs, were reduced by >75% with capecitabine vs 5-FU/LV (cost savings £1318), with lifetime gain in QALMs of 9 months. Medical resource utilisation is significantly decreased with capecitabine vs 5-FU/LV, with cost savings to the NHS and society. Capecitabine is also projected to increase life expectancy vs 5-FU/LV. Cost savings and better outcomes make capecitabine a preferred adjuvant therapy for Dukes' C colon cancer. This pharmacoeconomic analysis strongly supports replacing 5-FU/LV with capecitabine in the adjuvant treatment of colon cancer in the UK.