CHEMOTHERAPY IN GASTRIC-CANCER - AN ECONOMIC-EVALUATION OF THE FAM (5-FLUOROURACIL, ADRIAMYCIN, MITOMYCIN-C) VERSUS ELF (ETOPOSIDE, LEUCOVORIN, 5-FLUOROURACIL) REGIMENS

The prognosis in gastric cancer has been almost unchanged for the last 20 years. At the time of diagnosis the majority of patients have diss eminated disease. The 5-year survival is only about 15%. Several effor ts with numerous antineoplastic regimens have been studied. The most w idely used regimen has been the FAM (5-fluorouracil, adriamycin, mitom ycin C) regimen. Because of the cardiotoxicity and dose intensity of t he FAM regimen, a low toxicity regimen, the ELF (etoposide, leucovorin , 5-fluorouracil) regimen, has been introduced. We present the data fr om the treatment of 26 patients (17 FAM, 9 ELF) with advanced gastric cancer at the University Hospital of Tromso. The monthly costs of FAM and ELF treatment were calculated to a price of pound 553 and pound 29 76 (British pounds). The median survival of 5 months (FAM) and 6 month s (ELF) is in accordance with other studies. Assuming that the median survival in our study is correct, the cost of one year saved was pound 123,834, while the cost of one QALY (quality adjusted life year) empl oying the ELF compared to the FAM regimen was pound 104,334. We conclu de that the standard ELF regimen too expensive in the treatment of gas tric cancer.