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

Table 22.11 Summary of findings from reviews of cost-effectiveness of chemotherapy agents
and regimes
Study Country Study questions Conclusion
Redaelli et al 47
Scott and
Twelves 123
United
States
United
Kingdom
Matasar et al 77 United
States
Review costeffectiveness
evidence for
alternative
chemotherapy
regimens
Review costeffectiveness
of
new chemotherapy
drugs vs FU
(concentrating on
drug costs)
Review costeffectiveness
of
chemo regimens in
elderly patients
New treatments (particularly oral tegafur)
appear to be more cost-effective than 5-
FU-based therapies for advanced and
metastatic cancer. Depending on country,
setting (1st-line, 2nd-line or rescue
therapy) and comparative treatments,
ICERs of irinotecan and raltitrexed are
generally within the threshold of $US30–
50,000 ($A44,323–73,872)/LYG. Both
have significant and consistent economic
advantage over 5-FU. There is a limited
evidence for adjuvant therapy. It appears
FU + levamisole or FA are cost-effective
(if 5% improvement in 5yr survival rate),
with possible ICERs of $US2094–6500
($A3094–9,603)/LYG. More research is
needed.
Capecitabine, raltitrexed, irinotecan and
oxaliplatin alone, or in combination with 5-
FU or FU/FA, are cost-effective compared
to FU or FU/FA alone. Cost savings range
from $US626–5000 ($A925–7387) per
patient, ICERs/LYG range from
$US21,591–59,403 ($A31,899–87,764)
(1st-line treatment) and $US9344–10,137
($A13,805–14,977) (2nd-line treatment).
Comparisons between newer agents is
difficult due to non standardised methods,
and judgments may differ between
countries, tumour type, available
treatments, etc.
ICER of fluorouracil-based regimens,
depending on delivery strategy, use of
model agents and stage of cancer, vary
from $US2000–20,000 ($A2790–27,897)
per QALY gained. Reported ICER of
$US10,000 ($A13,949) per QALY gained
for irinotecan is likely to be an
underestimate and requires further
research. Raltitrexed, capecitabine and
oxaliplatin also require further research.
UFT appears to be potentially cost saving.
HAL cannot be recommended for elderly
patients
Cost effectiveness
279