XELOX ± Bevacizumab compared to FOLFOX4 ± Bevacizumab in first line metastatic colorectal cancer in a non-reimbursed health care system: A cost analysis

ABSTRACT

INTRODUCTION: XELOX is non-inferior to FOLFOX-4 as a first-line treatment for metastatic colorectal cancer. This study compares the costs associated with XEL0X+/-bevacizumab versus FOLFOX4+/-bevacizumab 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 60 kg with BSA 1.66. The outcome data were derived from the N016966 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 hospital days, ambulatory consultations, concomitantmedication, 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 XEL0X+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 XEL0X+BEV resulted in a cost saving of PhP 186,144 per patient compared with FOLFOX4+BEV.CONCLUSION: XEL0X+/-BEV is less costly than FOLFOX4-F/-BEV in an out-of-pocket Philippine tertiary hospital setting from the patient's perspective.