Economic evaluation of capecitabine use as first line treatment in patients with advanced gastric carcinoma in Portugal.

Abstract

Gastric cancer is a highly prevalent disease in Portugal with impact on morbidity and mortality. The approach to a stomach cancer depends on the disease status and prognosis at the time of diagnosis. Surgical resection is the only potentially curative treatment. Up to now, palliative chemotherapy has been the only advantageous therapy option for patients with unresectable advanced gastric cancer or after recurrence, with a median survival of six to nine months. Among the drugs with a known antitumor activity, 5-fluorouracil (5-FU) and cisplatin have been widely used in advanced gastric cancer, either in monotherapy, or in combination. However, 5-FU is administered by intravenous infusion, which requires the insertion of a central venous catheter or the patient's hospitalization and is therefore inconvenient and uncomfortable.Evaluation of the incremental cost in Portugal of using capecitabine as first line treatment in patients with advanced gastric carcinoma as an alternative to 5-FU, both used in association with cisplatin.The study was carried out using the Portuguese National Health Service (NHS) perspective, through an analysis of cost minimization, considering data from a phase III clinical study (ML17032) that demonstrates the non-inferiority of capecitabine versus 5-FU, both in association with cisplatin. A Markov model was developed to evaluate the treatment costs, using a cohort of patients with advanced gastric carcinoma and a timeframe of five cycles. This analysis considered only direct costs.The incremental cost analysis demonstrated savings of 5,868.60 euro per patient with capecitabine therapy (base scenario). The results obtained when considering alternative scenarios (sensitivity analysis), particularly that related to the 5-FU Administration method, reinforce the base scenario savings result.The analysis conducted demonstrated that the use of capecitabine+cisplatin (CAP-cis) allows a cost reduction when compared to the alternative 5-FU+cisplatin (5-FU-cis). Capecitabine clinical efficacy is not inferior to 5-FU and it has a more convenient and comfortable administration method. It also eliminates the risk of complications associated with intravenous perfusion, consequently reducing the need for hospitalisation. The replacement of 5-FU with capecitabine is shown to be economically advantageous.