Ward S E, Kaltenthaler E, Cowan J, Marples M, Orr B, Seymour M T
School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK.
Br J Cancer. 2006 Jul 3;95(1):27-34. doi: 10.1038/sj.bjc.6603215.
Two oral fluoropyrimidine therapies have been introduced for metastatic colorectal cancer. One is a 5-fluorouracil pro-drug, capecitabine; the other is a combination of tegafur and uracil administered together with leucovorin. The purpose of this study was to compare the clinical effectiveness and cost-effectiveness of these oral therapies against standard intravenous 5-fluorouracil regimens. A systematic literature review was conducted to assess the clinical effectiveness of the therapies and costs were calculated from the UK National Health Service perspective for drug acquisition, drug administration, and the treatment of adverse events. A cost-minimisation analysis was used; this assumes that the treatments are of equal efficacy, although direct randomised controlled trial (RCT) comparisons of the oral therapies with infusional 5-fluorouracil schedules were not available. The cost-minimisation analysis showed that treatment costs for a 12-week course of capecitabine (Pounds 2132) and tegafur with uracil (Pounds 3385) were lower than costs for the intravenous Mayo regimen (Pounds 3593) and infusional regimens on the de Gramont (Pounds 6255) and Modified de Gramont (Pounds 3485) schedules over the same treatment period. Oral therapies result in lower costs to the health service than intravenous therapies. Further research is needed to determine the relative clinical effectiveness of oral therapies vs infusional regimens.
两种口服氟嘧啶疗法已被用于转移性结直肠癌的治疗。一种是5-氟尿嘧啶前体药物卡培他滨；另一种是替加氟与尿嘧啶联合亚叶酸一起给药。本研究的目的是比较这些口服疗法与标准静脉注射5-氟尿嘧啶方案的临床有效性和成本效益。进行了一项系统的文献综述以评估这些疗法的临床有效性，并从英国国家医疗服务体系的角度计算了药物采购、药物给药及不良事件治疗的成本。采用了成本最小化分析；尽管缺乏口服疗法与静脉输注5-氟尿嘧啶方案的直接随机对照试验（RCT）比较，但该分析假定这些治疗具有同等疗效。成本最小化分析表明，在相同治疗期间，卡培他滨12周疗程（2132英镑）和替加氟与尿嘧啶（3385英镑）的治疗成本低于静脉注射梅奥方案（3593英镑）以及德格拉蒙方案（6255英镑）和改良德格拉蒙方案（3485英镑）的静脉输注方案。口服疗法给医疗服务带来的成本低于静脉疗法。需要进一步研究以确定口服疗法与静脉输注方案的相对临床有效性。
