OBJECTIVES: The main objective of the study was to compare the cost effectiveness of 5-fluorouracil and capecitabine based regimens for management of colorectal cancer in KNH. In addition, a budget impact analysis of the adoption of capecitabine based regimen was conducted.

METHODS: A retrospective cohort study was conducted in the oncology wards to identify the key resources used in managing colorectal cancer and its complications. Key informant interview was carried out amongst the billing and procurement officers to collect information on cost of procuring drugs and other resources used for management of colorectal and its complications. Cost utility analysis was conducted using the markov decision model.The study was conducted from a provider perspective with a time horizon of 5 years. Effectiveness data was derived from literature. A budget impact analysis was conducted to assess the cost impact of the adoption of capecitabine based regimen on the budget at Kenyatta National Hospital. The quantitative data on costs was tabulated and summarized in MS Excel spreadsheet. The R version 3.6.0, “heemod” package was used for costing, probabilistic and sensitivity analysis.

RESULTS: Fluorouracil- based regimen was the most expensive. Capecitabine-based was found to be the most cost effective regimen with an incremental cost effectiveness ratio (ICER) of Ksh.-38632.74 per quality adjusted life years (QALY) gained. The ICER was negative for Capecitabine-based due to the lower cost and more QALY gained. The results show that the use of Capecitabine-based for managing colorectal cancer is cost saving each year. The impact of adopting Capecitabine-based on the KNH annual budget and medicines budget over 5 years ranged between 2.27% to 2.90%.

CONCLUSIONS: Capecitabine-based is the most cost effective regimen as compared to 5FU from the provider perspective and should be considered as a drug of choice in the management of colorectal cancer in Kenya