Pharmacoeconomic evaluation of tegafur-uracil (UFT) vs fluorouracil for the management of colorectal cancer in Brazil and Argentina
Pharmacoeconomic evaluation of tegafur-uracil (UFT) vs fluorouracil for the management of colorectal cancer in Brazil and Argentina
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DOI：
10.2165/00044011-199713020-00005
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发表时间：
1997-02-01
影响因子：
3.2
通讯作者：
Sinha, N
中科院分区：
文献类型：
--
作者：
Murad, AM;deAndrade, CA;Sinha, N
结直肠癌的治疗继续给世界各地的肿瘤学家带来重大挑战。尿嘧啶和替加氟(UFT)作为一种口服药物，代表了一种新的以患者为中心的治疗恶性肿瘤的方法，除了静脉注射氟尿嘧啶(5-FU)方案外，几乎没有其他治疗方案。与持续5-FU输注相比，UFT获得同等临床结果的能力，以及其口服配方和轻微的毒性特征，为财务分析提供了一个令人信服的背景。因此，在考虑采用这种化疗方案时，对治疗属性和效果进行经济评估将是谨慎和必要的。我们在巴西和阿根廷开发了一个药物经济学模型，从每个国家集合的医生小组中确定与化疗管理相关的临床实践和不良事件管理实践。然后对实践模式和临床事件进行资源利用趋势评估。这一药物经济学分析的视角是医疗保健支付者的视角。将特定国家的收费数据应用于确定的资源，以得出接受6个周期的5-FU疗程的每个患者的平均成本，这些患者接受左旋咪唑和/或亚叶酸钙作为调节剂，而不是模拟的口服UFT/亚叶酸钙方案。作为比较，口服UFT/亚叶酸钙方案是根据专家小组的输入进行建模的。不良事件和发生率数据来源于两种药物的临床试验数据。分析了这两种药物在治疗转移性疾病和作为辅助治疗方面的作用。在巴西进行的成本最小化分析的主要结果显示，在佐剂环境下，两种方案的治疗成本大致相同。在分析转移性治疗方案时，每个患者的成本相差335美元(R=雷亚尔--巴西货币)，而倾向于UFT方案。在阿根廷，UFT方案产生了更显著的差异，在辅助环境下，UFT方案每名患者的成本($P=比索-阿根廷货币)比5-FU方案低。在转移性疾病的治疗中，UFT方案比5-FU方案为每个患者节省了1188美元。这些差异主要是由UFT的轻度毒性概况及其相应的不太严重的不良事件管理实践模式推动的。此外，口服UFT方案与静脉注射5-FU方案相比，易于给药，降低了总护理成本，并可能影响患者的生活质量。药物经济学结果表明，在巴西和阿根廷，UFT方案是标准5-EU方案治疗结直肠癌的一种有用和经济的替代方案。
The treatment of colorectal cancer continues to pose major challenges for oncologists throughout the world. Uracil and tegafur (UFT), as an oral agent, represents a new patient-focused approach to managing a malignancy with few treatment alternatives other than an intravenous fluorourncil (5-FU)-based regimen. The ability of UFT to achieve equivalent clinical outcomes compared with continuous 5-FU infusion, along with its oral formulation and mild toxicity profile, provide a compelling backdrop for fiscal analysis. An economic assessment of therapy attributes and effects would, therefore, be prudent and necessary when deliberating the adoption of this chemotherapy regimen.We developed a pharmacoeconomic model in Brazil and Argentina identifying clinical practices associated with chemotherapy administration and adverse event management practices from a panel of physicians assembled in each country. Practice patterns and clinical events were then evaluated for resource utilisation trends. The perspective of this pharmacoeconomic analysis was that of the healthcare payor. Country-specific charge data were applied to the identified resources to arrive at an average cost per patient receiving a 6-cycle course of 5-FU with either levamisole and/or leucovorin as a modulator vs a modelled oral UFT/leucovorin regimen. As a comparator, the oral UFT/leucovorin regimen was modelled based on the expert panel's input. Adverse events and incidence data were derived from clinical trial data for both agents. Both agents were analysed in the treatment of metastatic disease and as adjuvant therapy. The principal findings of a cost-minimisation analysis in Brazil revealed approximately equivalent treatment costs for both regimens in the adjuvant setting. When analysing the metastatic treatment arm, costs diverged by $R335/per patient ($R = Reals - the currency of Brazil) in favour of a UFT regimen. The profile in Argentina yielded more dramatic differences, with a UFT regimen costing $P782/per patient ($P = Pesos - the currency of Argentina) less than a 5-FU regimen in the adjuvant setting. In the treatment of metastatic disease, a UFT regimen provided $P1188/per patient in savings over a 5-FU regimen. These differences are predominantly driven by the mild toxicity profile of UFT and its corresponding less severe adverse event management practice patterns. In addition, the oral formulation of UFT versus intravenous 5-FU provides for ease of administration, lowering the total cost of care as well as likely impacting on the patient's quality of life.The pharmacoeconomic results suggest that a UFT regimen is a useful and economical alternative to the standard 5-EU regimen in the treatment of colorectal cancer in Brazil and Argentina.