Pharmacoeconomic Evaluation of Tegafur-Uracil (UFT) vs Fluorouracil for the Management of Colorectal Cancer in Brazil and Argentina

Abstract

The treatment of colorectal cancer continues to pose major challenges for oncologists throughout the world. Uracil and tegafur (UFT), as an oral agent, represents a new patient-focused approach to managing a malignancy with few treatment alternatives other than an intravenous fluorouracil (5-FU)-based regimen. The ability of UFT to achieve equivalent clinical outcomes compared with continuous 5-FU infusion, along with its oral formulation and mild toxicity profile, provide a compelling backdrop for fiscal analysis. An economic assessment of therapy attributes and effects would, therefore, be prudent and necessary when deliberating the adoption of this chemotherapy regimen. We developed a pharmacoeconomic model in Brazil and Argentina identifying clinical practices associated with chemotherapy administration and adverse event management practices from a panel of physicians assembled in each country. Practice patterns and clinical events were then evaluated for resource utilisation trends. The perspective of this pharmacoeconomic analysis was that of the healthcare payor. Country-specific charge data were applied to the identified resources to arrive at an average cost per patient receiving a 6-cycle course of 5-FU with either levamisole and/or leucovorin as a modulator vs a modelled oral UFT/leucovorin regimen. As a comparator, the oral UFT/leucovorin regimen was modelled based on the expert panel's input. Adverse events and incidence data were derived from clinical trial data for both agents. Both agents were analysed in the treatment of metastatic disease and as adjuvant therapy. The principal findings of a cost-minimisation analysis in Brazil revealed approximately equivalent treatment costs for both regimens in the adjuvant setting. When analysing the metastatic treatment arm, costs diverged by $R335/per patient ($R = Reals - the currency of Brazil) in favour of a UFT regimen. The profile in Argentina yielded more dramatic differences, with a UFT regimen costing $P782/per patient ($P = Pesos - the currency of Argentina) less than a 5-FU regimen in the adjuvant setting. In the treatment of metastatic disease, a UFT regimen provided $P1188/per patient in savings over a 5-FU regimen. These differences are predominantly driven by the mild toxicity profile of UFT and its corresponding less severe adverse event management practice patterns. In addition, the oral formulation of UFT versus intravenous 5-FU provides for ease of administration, lowering the total cost of care as well as likely impacting on the patient's quality of life. The pharmacoeconomic results suggest that a UFT regimen is a useful and economical alternative to the standard 5-FU regimen in the treatment of colorectal cancer in Brazil and Argentina.

Phase II study of UFT with leucovorin and irinotecan (TEGAFIRI): first-line therapy for metastatic colorectal cancer

“…treatment . UFT may be administered without visits to the hospital, resulting in reduced treatment costs (Murad et al, 1997) and increased convenience for the patient. The oral schedule also allows patients to temporarily withhold a dose of the drug if adverse events emerge, for example grade 2 diarrhoea, thereby preventing the toxicity from becoming severe.…”

Clinical and cost-effectiveness of capecitabine and tegafur with uracil for the treatment of metastatic colorectal cancer: systematic review and economic evaluation

“…Two economic evaluations by Murad and colleagues 51,52 were found, based on the same South American study comparing UFT with 5-FU. Two resource use studies were also identified, one relating to medical resource use in the two capecitabine trials 53 and one to resource use in the Carmichael UFT/LV trial.…”

“…Murad and colleagues, 1997 51,52 An economic evaluation was undertaken of the treatment of patients with colorectal cancer in Brazil and Argentina. This study estimated the total cost of a course of treatment over 18 months with UFT/LV compared with a course of treatment with 5-FU.…”

“…The unpublished sponsor submission from BristolMyers Squibb (BMS) 48 reviewed the South American study by Murad and colleagues 51,52 and also cost analyses by Avon, Somerset, Wiltshire Cancer Services (November 2000) and Devon and Cornwall Cancer Services (March 1999) as well as a NICE rapid review of irinotecan, oxaliplatin and raltitrexed for the treatment of advanced colorectal cancer. 24 It also included a brief summary of an economic evaluation commissioned by BMS comparing UFT/LV with intravenous 5-FU/LV treatment.…”

“…Although the quality of evidence is good in the resource-use studies, 53,54 these studies do not report costs. Although the South American economic evaluations 51,52 claim to show cost savings associated with UFT usage, the quality of evidence is poor, as the resource-use data do not come from trials or broadly based surveys, the rate of resource use was not given and it is doubtful whether the aggregated cost data are applicable to current UK practice. Hence there are no evaluations that can be directly translated to the UK context.…”