Health economic analysis of fluoropyrimidine-based therapies of colorectal cancer from the perspective of statutory sickness funds

Aims: 1) to identify the treatment costs of different standard fluoropyrimidine-based therapies, i. e., the Mayo-Clinic and AIO/Ardalan regimens, under real-life conditions in settings routinely used for chemotherapy administration in Germany (inpatient, day-clinic or office-based oncologists) and 2) to investigate the cost implications of the routine use of capecitabine, an oral alternative for the treatment of metastatic colorectal cancer. Methods: We analysed the actual fee-listings of office based oncologists and projected the results to several hospital-based treatment settings and to oral treatment with capecitabine from the perspective of statutory sickness funds. Results: Office-based setting: the highest quarterly treatment costs of € 9,874 were found for the AIO/Ardalan-regimen, followed by the Mayo-Clinic regimen, which incurred costs of € 2,497. The cheapest treatment option was capecitabine with quarterly costs of € 1,610. Day-clinic setting: the costs of the Mayo-Clinic protocol amounted to € 2,036 in a municipal hospital and € 8,455 in a university hospital. The respective costs for the AIO/Ardalan regime were € 1,294 and € 5,374. In-patient setting: the Mayo-Clinic protocol costs were € 3,143 in a municipal hospital and € 10,5609 in a university hospital. The respective costs found for the AIO/Ardalan-regimen were € 1,998 and € 6,717. Conclusion: From a health economic perspective, substantial cost savings for health insurances may be realised if patients with colorectal carcinoma were treated in the office-based setting with capecitabine instead of a hospital-based treatment. Economic consequences would be positive for municipal hospitals (avoided losses) and negative for university hospitals. Further savings could be realised if drug prices in hospital and retail pharmacies were harmonised.