Pharmaco-Economic Evaluation of Therapeutic Drug Monitoring of 5-Fluorouracil in the Treatment of Colorectal Cancer

OBJECTIVES: Colorectal cancer (CRC) is one of the most frequently diagnosed cancers worldwide. 5-Fluorouracil (5-FU) is a chemotherapy drug commonly used for treating CRC. However, dosing based on body surface area (BSA) can lead to a large variability in blood concentrations and adverse effects (AEs). Therapeutic drug monitoring (TDM) of 5-FU has shown promising outcomes in optimal dosing, improved efficacy, and reduced toxicities. This study evaluates the budget impact of implementing TDM of 5-FU in CRC patients.

METHODS: A budget impact analysis (BIA) was conducted from the payer's perspective over a 5- year time horizon. The study population included stage 3 and 4 CRC patients at Beau-Fraisier Cancer Treatment Center in Algiers, Algeria. Treatment costs, AE management costs, and TDM costs were evaluated. Two scenarios were analyzed: current practice without TDM and a future scenario with a 20% annual increase in TDM adoption.

RESULTS: Implementing TDM leads to significant cost savings compared to current practice. In the future scenario, the total budget over five years is € 740,912.34 compared to € 895,868.81 with current practice, with a total savings of € 154,956.47. The incremental budget increased each year, from € 9,946.28 in 2025 to € 52,556.69 in 2029. Per patient, TDM saves an average of € 182.94 annually and € 914.7 over five years. The cost savings resulted from a reduction in AEs with TDM implementation.

CONCLUSIONS: Adopting TDM of 5-FU in CRC patients has shown a promising solution to reduce the economic burden of the current treatment practice. The budget impact is substantial at a single center and suggests a more prominent impact if implemented nationwide. These findings support the cost-effectiveness of implementing TDM in clinical practice for CRC treatment with 5-FU.