Cost Evaluation of Metastatic Colorectal Cancer Treatment in the Brazilian Public Healthcare System

Abstract

Objective: The study aimed at evaluating and comparing healthcare-related costs for metastatic colorectal cancer treatment among patients receiving systemic (chemotherapy or biotherapy) therapy, considering both costs per treatment cycle and total costs per patient. Methods: This was a cross-sectional, econometric study conducted in a public, tertiary referral hospital in Brazil, which is supported by national and state level funding. Data were collected between January 01, 2009 and October 31, 2013. Micro-costing method was employed to estimate costs related to medication, laboratory tests, imaging tests, drug preparation and administration. Results: The XELOX plus bevacizumab therapy presented the highest average cost per cycle, 7,701 Brazilian reals, followed by FOLFIRI plus bevacizumab, with an average cost of 6,927 Brazilian reals. Costs of treatment regimens containing capecitabine and/or monoclonal antibody (capecitabine monotherapy, cetuximab, cetuximab plus irinotecan, FOLFIRI plus bevacizumab, XELIRI, XELIRI plus bevacizumab, XELOX and XELOX plus bevacizumab) had a greater impact on total cost of therapy. In the mFOLFOX6 and FOLFIRI regimens, the total cost of therapy was mostly influenced by the cost per cycle (51%) and the cost related to drug administration (50%). Conclusions: the Brazilian universal healthcare system does not cover monoclonal antibody therapies and the chemotherapy regimens FOLFIRI and mFOLFOX6 for colorectal cancer, since they surpass the monthly reimbursement amounts provided by the system. On the other hand, XELOX regimen fits within the budget established by the system, representing a promising alternative for colorectal cancer treatment, especially taking into account current economic limitations.