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 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.