OBJECTIVES: Capecitabine’s mCRC license was recently extended supporting its use in combination therapy. XELOX (oral capecitabine + intravenous (IV) oxaliplatin) in 21 day cycles is non-inferior to FOLFOX-6 (IV 5-fluorouracil, folinic acid and oxaliplatin) in 14 day cycles (Ducreux et al, ASCO 2007). This evaluation was conducted to provide empirical evidence of the relative NHS resource implications of using XELOX and FOLFOX-6. METHODS: A prospective time-and-motion study was conducted in two UK hospitals. Preparation, dispensing and administration of infusions and insertion of a central venous access device (CVAD) were observed by an independent researcher. Staff and capital item utilisation were recorded. Resource utilisation per course was derived from mean observed activity durations multiplied by per protocol frequency over an assumed typical treatment duration of 24 weeks. RESULTS: Forty-six episodes of dispensing related activity were observed along with 33 administration episodes, XELOX (n=18) and FOLFOX-6 (n=15), and 7 of CVAD insertion. A mean of 98 minutes (SD=15) staff time was required for CVAD insertion.  Mean staff time for preparation and dispensing of XELOX and FOLFOX-6 was 24 minutes (SD=11) vs. 31 minutes (SD=4), and for administration 39 minutes (SD=15) vs. 68 minutes (SD=23). Per 24 week course, staff contact time for XELOX was 39% and 43% that of FOLFOX-6 in centres 1 and 2 respectively, representing a difference of 11.5 hours and 12.2 hours. Additional chair time per patient course for FOLFOX-6 compared to XELOX was 14.5 hours and 23.2 hours for centres 1 and 2 respectively. CONCLUSIONS: XELOX requires less pharmacy and administration time, and use of capital items, per cycle than FOLFOX-6 and did not require the insertion of a CVAD. This combined with a longer cycle length means that XELOX is associated with considerable efficiency savings in terms of NHS staff and patient time compared to FOLFOX-6.