PHARMACOECONOMIC EVALUATION OF TEGAFUR-URACIL (UFT) VS FLUOROURACIL FOR THE MANAGEMENT OF COLORECTAL-CANCER IN BRAZIL AND ARGENTINA

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 ma lignancy with few treatment alternatives other than an intravenous flu orourncil (5-FU)-based regimen. The ability of UFT to achieve equivale nt clinical outcomes compared with continuous 5-FU infusion, along wit h its oral formulation and mild toxicity profile, provide a compelling backdrop for fiscal analysis. An economic assessment of therapy attri butes and effects would, therefore, be prudent and necessary when deli berating the adoption of this chemotherapy regimen. We developed a pha rmacoeconomic model in Brazil and Argentina identifying clinical pract ices associated with chemotherapy administration and adverse event man agement practices from a panel of physicians assembled in each country . Practice patterns and clinical events were then evaluated for resour ce utilisation trends. The perspective of this pharmacoeconomic analys is 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 de rived from clinical trial data for both agents. Both agents were analy sed in the treatment of metastatic disease and as adjuvant therapy. Th e principal findings of a cost-minimisation analysis in Brazil reveale d approximately equivalent treatment costs for both regimens in the ad juvant setting. When analysing the metastatic treatment arm, costs div erged by $R335/per patient ($R = Reals - the currency of Brazil) in fa vour 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 provide d $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 provi des for ease of administration, lowering the total cost of care as wel l as likely impacting on the patient's quality of life. The pharmacoec onomic results suggest that a UFT regimen is a useful and economical a lternative to the standard 5-EU regimen in the treatment of colorectal cancer in Brazil and Argentina.