An economic evaluation of Tomudex (raltitrexed) and 5-fluorouracil plus leucovorin in advanced colorectal cancer

Our objective was to establish the balance between costs and effects of tre atment with Tomudex (raltitrexed) as an alternative to treatment with B-flu orouracil (5-FU) plus leucovorin (LV) in patients with advanced colorectal cancer. Data were used from an international, open label randomized clinica l trial. Costs were calculated by multiplying resource utilization data wit h Dutch estimates of unit costs. Effects have been expressed in terms of 6 months and 1 year survival, and in terms of the number of patients without severe adverse events including WHO grade 3 and 4 leucopenia, mucositis, an emia and severe asthenia. Cost effectiveness is expressed in terms of costs per additional day of survival and costs per additional patient without an y severe adverse event. The clinical results did not show significant survi val differences implying great uncertainty about the cost-effectiveness of raltitrexed in terms of additional costs per additional life-year gained. H owever, 80% of the initially higher cost of raltitrexed ($3132 per patient) is compensated by savings due to a more convenient administration scheme l eading to a net cost of $626 per patient treated. Weighed against the decre ase in adverse events, a cost-effectiveness ratio results of $3936 per addi tional patient free of any severe adverse event, More favorable estimates r esult when the convenience of the administration scheme is valued in positi ve monetary terms, [(C) 1999 Lippincott Williams & Wilkins.]