OBJECTIVES

To conduct cost-utility and budget impact analyses (BIA) of out-patient oral chemotherapy versus in-patient conventional intravenous chemotherapy for colorectal cancer(CRC) stage III treatment in Thailand.

METHODS

The analysis was performed to estimate the relevant lifetime costs and health outcomes of CRC stage III patients based on a societal perspective using Markov model. Input parameters were based on previous publications and primary data of Thai University Hospital patients. Results were reported as incremental cost-effectiveness ratios (ICERs) in 2018 US dollars(USD) per quality-adjusted life year (QALY) gained. Cost-effectiveness results were interpreted by the willingness-to-pay threshold of 4,952 USD/QALY gained. Also, five-year BIA were performed.

RESULTS

When compared to the current standard regimen, i.e. 5-FU/LV for stage III CRC then in-patient FOLFOX for progressive stage, 5-FU/LV then out-patient XELOX is a cost-saving strategy. The oral capecitabine then XELOX is also considered cost-effective with the ICERs of 2,160.78 USD per QALY gained. When concerned the next best alternative strategy, 5-FU/LV then XELOX is the only best strategy that is cost-effective. However, capecitabine then XELOX can become cost-effective when compared to 5-FU/LV then XELOX if the cost of capecitabine is reduced by 39%. The treatment strategies involved with in-patient chemotherapy, i.e. FOLFOX and FOLFIRI, are not cost-effective in Thailand’s context. The BIA showed that at current generic drug prices, the standard regimen still impacts the least budget, about 9.6 million USD. The 5-FU/LV then XELOX requires about 50% higher in budget, 13.6 million USD.

CONCLUSIONS

The treatment regimen which can be administered as oral or out-patient intravenous are the potential cost-effective strategies of CRC stage III treatment in Thailand. To begin the treatment with oral capecitabine, its cost still needed to be significantly reduced before including in the National List of Essential Medicine which will gain the access rate of oral chemotherapy in Thailand.