Capecitabine is associated with lower chemotherapy-related expenditures than those associated with gemcitabine in women with metastatic breast cancer.
Authors: Lee M , Schulman KL , Zelt S , Harris L 
Published: December 2010

Abstract
Abstract #6108
Background: There is growing concern about the impact of cancer therapies on escalating medical costs, with considerable focus on the high unit cost of new therapies. The current study quantified the impact of all chemotherapy-related costs (drug acquisition, drug administration, and related complications) on direct medical expenditure among patients with metastatic breast cancer (mBC) who were treated with capecitabine monotherapy or gemcitabine monotherapy.&#x2028; Methods: Women with mBC who were treated with gemcitabine or capecitabine between 1/1/2003 and12/31/2006 were identified from the Thomson Reuters Marketscan® database. Capecitabine users were propensity matched to gemcitabine users to address selection bias and to achieve balanced groups. Complications evaluated included myelosuppression, infection, constitutional symptoms, and GI-related events. The Cox proportional hazards model was used to assess relative risk of an event, while general linear models were used to estimate monthly complication cost, chemotherapy cost, and overall monthly expenditure.&#x2028; Results: A total of 252 capecitabine users were propensity matched 1:1 to gemcitabine users. Mean adjusted monthly expenditure was significantly lower among capecitabine users ($6930 vs $12,716 for gemcitabine, P&lt;.0001). The difference was driven by significantly lower complication costs (P&lt;.0001) and chemotherapy acquisition/administration costs (P&lt;.0001). Among capecitabine patients, 30% of the total mean monthly expenditure was attributed to chemotherapy treatment (15% complication related, 15% acquisition/administration), versus 51% (26% complication related, 25% acquisition/administration) for gemcitabine patients. Lower complication costs during capecitabine treatment episodes were due to reduced frequency of any of the 23 complications evaluated (HR=0.33, P&lt;.0001). Capecitabine users were at a significantly lower risk for myelosuppression (HR=0.28, P&lt;.0001), constitutional symptoms (HR=0.62, P=.001), and GI events, which led to the use of prescription medications or deemed clinically significant (HR=0.24, P&lt;.0001). The decrease in the rate of complications for capecitabine versus gemcitabine users resulted in significantly lower costs associated with myelosuppression ($485 vs $1607, respectively, P&lt;.0001) and GI events ($178 vs $674, respectively, P&lt;.0001). Lower chemotherapy costs during capecitabine treatment episodes versus gemcitabine treatment episodes were driven by significantly reduced costs associated with chemotherapy administration ($68 vs $466, respectively, P&lt;.0001) and drug acquisition ($967 vs $2668, respectively, P&lt;.0001).&#x2028; Conclusion: Patients with mBC who were treated with capecitabine monotherapy incurred significantly lower total health care costs than gemcitabine monotherapy patients. The difference in total cost was driven by lower costs associated with chemotherapy-related complications and chemotherapy acquisition/administration for patients treated with capecitabine.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6108.