An economic comparison of the net clinical benefit and treatment costs of raltitrexed and 5-fluorouracil + leucovorin (Mayo regimen) in advanced colorectal cancer

Background This paper describes an economic evaluation in which raltitrexed (Tomudex®†) was compared with 5-fluorouracil (5-FU) + leucovorin (LV), and where net clinical benefits were related to differential health service costs. Raltitrexed, a specific inhibitor of thymidylate synthetase, has shown anticancer activity against a range of solid tumours. Materials and Methods In a large, open, randomised, multicentre study in patients with advanced colorectal cancer, raltitrexed (n = 223) and 5-FU plus LV (n = 216) showed similar efficacy in terms of patient survival and objective response (i.e. tumour shrinkage rates). Palliative benefits were seen in both groups of patients and suggest that patients with stable disease are as likely to show improvement as those with a tumour response. Reductions compared with 5-FU plus LV in the number of toxicity days (median 1.5 vs 8 treatment days) and administration days (6 vs 22 days) with raltitrexed were consistent with a net clinical benefit. Results A cost minimisation analysis that drew on data from a number of sources showed direct medical costs per month to be similar for the two treatments (£781 for raltitrexed vs £834 for 5-FU + LV). Conclusions Raltitrexed therefore represents a clinically effective alternative to 5-FU plus LV (Mayo regimen) and offers net clinical benefit to patients with advanced colorectal cancer at no apparent additional cost. © 1999 Brookwood Medical Publications Ltd.