An analysis of drug costs for the management of chemotherapy-related side effects in advanced colorectal cancer

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Abstract
Purpose. To assess whether there is a difference in associated drug costs for the management of chemo therapy-related side effects for patients with advanced colorectal cancer treated with raltitrexed (Tomudex, Zeneca Limited) or 5-FU plus folinic acid (Mayo regimen). Data Sources. The drugs used for the manage ment of side effects were determined using a UK cohort (n = 62) taken from a large phase III ralti trexed clinical study. This study compared the toler ability and efficacy of raltitrexed vs 5-FU plus low- dose folinic acid and reported a significantly lower incidence of WHO grade 3/4 mucositis and leucope nia with raltitrexed. Drug costs were sourced using the British National Formulary, the Monthly Index of Medical Specialities and the Chemist and Druggist. Drug costs for the management of individual chemo therapy-related side-effects were calculated for both treatment groups and the total mean cost was com pared using the Student t test. Costs associated with the use of drugs for the management of clinically similar side effects, for example, nausea and vomiting were also investigated. Results. There was a significant reduction in the mean total drug cost per patient for the management of chemotherapy-related side effects in the raltitrexed group compared to the 5-FU/folinic acid treatment group (£,64.27 vs £139.14; P = .0016). Infection was the most costly individual side effect for both treat ment groups but was lower in the raltitrexed cohort (£25.46 vs £59.93). Drug costs for the management of nausea and vomiting, pain and abdominal pain, and mucositis side effects were also considerably lower in the raltitrexed cohort. Conclusion. The significantly lower drug cost for the management of chemotherapy-related side effects for the raltitrexed patients in the UK cohort suggests that the lower WHO grade 3/4 toxicity observed with raltitrexed in the phase III study would also be associated with a reduction in drug costs for the management of chemotherapy-related side ef fects.
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