Costs incurred by patients undergoing advanced colorectal cancer therapy -A comparison of raltitrexed and fluorouracil plus folinic acid

Background: To assess the cost effectiveness of healthcare interventions fr om a societal perspective, it is necessary to include costs such as patient s' travel costs and the opportunity cost of patients' time spent consuming healthcare. Objective: To analyse patients' travel and time costs associated with 2 alt ernative drug therapies for advanced colorectal cancer: raltitrexed and flu orouracil plus folinic acid (leucovorin) [5FU + FA]. Design and setting: The analysis is based on a prospective substudy within a multinational randomised controlled trial of raltitrexed versus 5FU + FA. Patients and participants: 495 patients with advanced colorectal cancer wer e enrolled in the trial, 270 of whom completed the questionnaire on costs. Methods: Data were collected within the trial to estimate the numbers of jo urneys made to and from hospital by patients and the time lost from usual a ctivities over the period of therapy. A subset of patients were asked to co mplete a questionnaire to provide the information necessary to value time a nd travel costs in monetary terms. These data, together with UK transport c osts and forgone time values, were used to value the transport and opportun ity costs of time of all patients in the trial. Results: The total travel cost per patient was statistically significantly higher in the 5FU + FA group (p < 0.001; median of pound 31.50 with raltitr exed, pound 96.00 with 5FU + FA; 1997 prices); Overall time cost per patien t was also higher in the 5FU + FA group (p = 0.005; median of pound 168.80 with raltitrexed, pound 224.04 with 5FU + FA). Adding the two gives a media n total cost per patient of pound 206.08 [interquartile range (IQR) pound 1 08 to pound 482] among patients randomised to raltitrexed and pound 342.25 (IQR pound 214 to pound 555) for those in the 5FU + FA group (p < 0.001). T he sensitivity analysis showed that, even under extreme assumptions, raltit rexed imposed fewer time and travel costs on patients. These cost differenc es are likely, in part, to reflect the longer treatment times for 5FU + FA patients (median 16.9 vs 12.7 weeks). Conclusions: Different chemotherapy regimens for advanced colorectal cancer can impose different travel and time costs on patients. Over the period of treatment in a randomised controlled trial of 495 patients, those randomis ed to 5FU + FA were found to have a median travel plus time cost pound 136 per patient higher than those randomised to raltitrexed.