Capecitabine or Infusional 5-fluorouracil for Gastroesophageal Cancer: A Cost–Consequence Analysis

Background: In patients with advanced gastroesophageal cancer, the phase III Randomized ECF for Advanced and Locally Advanced Esophagogastric Cancer 2 (REAL-2) trial demonstrated equivalent clinical efficacy when capecitabine (x) was substituted for 5-fluorouracil (5FU) in the epirubicin–cisplatin–5FU (ECF) regimen. Methods: The present analysis compares the direct medical costs associated with both regimens. This cost–consequence analysis of direct medical costs took resource utilization data from the REAL-2 trial where available. Direct medical costs were derived from the perspective of the Canadian public health care system in 2008 Canadian dollars. Mean cost per patient on each treatment arm was calculated. Results: Drug costs from start of treatment until first progression, including pre- and post-chemotherapy medications and administration costs, totalled $5,344 for ECX as compared with $3,187 for ECF. Costs for treatment of adverse events were estimated at $2,621 for ECX as compared with $3,397 for ECF. An additional cost of $873 was associated with insertion of an implanted venous access. Total incremental cost of ECX over ECF was $508. Conclusions: In advanced gastroesophageal cancer, capecitabine is an attractive alternative to 5FU. Although the drug cost per se is greater, use of capecitabine is associated with decreased consumption of hospital resources. Not only does capecitabine fit with patient preference for oral therapy, it also avoids the inconvenience and complications of central venous access.