Clinical Practice Guidelines - National Health and Medical Research ...

Study Country Study questions Conclusion
Kerr and
O’Connor 107
Maroun et al
108
Ward et al 109
Smith et al 110
Glimelius et
al 111
Bonistalli et
al 112
United
Kingdom
Assessment of cost
and outcomes for
raltitrexed vs 5-FU
(Mayo regimen)
Canada Comparison of
UFT/FA vs
parenteral FU/FA
United
Kingdom
Assessment of cost
and outcomes for
capecitabine vs
UFT/LV vs three 5-
FU regimens —
(Mayo, modified de
Gramont and
inpatient de
Gramont), as 1st-line
treatment
Australia Comparison of 5-FU
+ levamisole vs no
chemotherapy after
full resection for
Dukes C patients
Sweden Comparison of 5-
FU+LV (palliative
chemotherapy) + best
supportive care vs
best supportive care
Italy Comparison of
adjuvant FU+
levamisole vs no
chemotherapy for
stage III cancer
There is no difference in response rate
and survival, but raltitrexed reduces
demand on clinic and pharmacy resources
(reduced toxicity (12.4 vs 16.7) and
administration (6 vs 22 days) without
increasing cost of monthly treatment
(₤781 [$A2039] [raltitrexed] vs ₤834
[$A2177] [5-FU]).
Cost of treatment per patient and per
cycle using UFT/FA is less than using
FU/FA. Total cost savings per patient per
cycle and per treatment were $CAN826
and $CAN3221 ($A1217 and $A4745).
Oral therapies are associated with costbenefits
but have no proven survival
benefit. There is no proven survival
difference for the 5-FU regimens. Cost
savings for capecitabine and UFT/LV vs
Mayo, modified de Gramont and de
Gramont were ₤1461, ₤1353 and ₤4123;
₤209, ₤101 and ₤2870 ($A3696, $A3422,
$A10,429, $A529, $A255 and $A7260).
Sensitivity analysis indicates savings for
capecitabine could range from ₤483
($A1222) vs modified de Gramont to
₤4123 ($A10,429) vs de Gramont;
Results for UFT/LV could range from
saving of ₤101 ($A255) vs modified de
Gramont to an additional cost of ₤445
($A1126) vs Mayo.
Inclusion of 5-FU results in incremental
cost of $A7000 with ICER of
$A2916/LYG and $A17,500/QALY
gained. Sensitivity analysis shows results
may vary from $A12,000–$A31,900.
Palliative chemotherapy is cost-effective
with an ICER/LYG of 102,000–
204,000SEK ($A25,166–50,332). Results
are sensitive to changes in survival
differences.
Adjuvant therapy with FU + levamisole
has favourable economic benefits (ICERs
= $US1422 ($A3239)/LYG, $US1501
($A3419)/QALY gained. Sensitivity
analysis confirms the results robust.
Cost effectiveness
275