XELOX +/- Bevacizumab compared to FOLFOX4 + Bevacizumab in First line Metastatic Colorectal Cancer in a Non-reimbursed Health Care System: A Cost Analysis

Jerry Y. Tan Chun Bing, Andrew A. Yacat and Dennis L. Sacdalan

Section of Medical Oncology, Department of Medicine, College of Medicine and
Philippine General Hospital, University of the Philippines Manila

Introduction. XELOX is non-inferior to FOLFOX-4 as a first-line treatment for metastatic colorectal cancer. This study compares the costs associated with XELOX+/-bevacizumab versus FOLFOX4+/-belvacizumab in a non-reimbursed, out of pocket Philippine health care system.

Methods. This is a cost-minimization analysis using Philippine General Hospital as base case and a typical Filipino patient of 60kg with BSA 1.66. The outcome data were derived from the NO16966 trial. These included the drugs capecitabine, 5-fluorouracil, oxaliplatin, and bevacizumab (BEV); chemotherapy cycles and corresponding hospital admission for each regimen; resources associated with treatment of adverse events such as hospital days, ambulatory consultations, concomitant medication, and central venous line insertion/removal, with costs and charges based on the local setting.

Results. Highest cost (direct and/or indirect) was for FOLFOX4+BEV, followed by XELOX+BEV, FOLFOX4, and then XELOX. The use of XELOX resulted in a cost saving of PhP 158,642 per patient compared with FOLFOX4. The use of XELOX+BEV resulted in a cost saving of PhP 186,144 per patient compared with FOLFOX4+BEV.

Conclusion. XELOX+/-BEV is less costly than FOLFOX4+/-BEV in an out-of-pocket Philippine tertiary hospital setting from the patient's perspective.

Key Words: cost analysis, XELOX, FOLFOX, bevacizumab, colorectal carcinoma