الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Metastatic colorectal cancer has a heavy burden on the patients, governments and the society due to enormous consumption of financial resources, mortalities and lower quality of life. Two popular protocols treating metastatic colorectal cancer are the CAPOX and FOLFOX protocol. The two protocols have proven to have similar safety and efficacy. However, the cost of both protocols is not equal. The cost of a protocol doesn’t mean just the cost of the chemotherapeutic agents. Each protocol has related costs including direct medical costs, direct non-medical costs and indirect costs. To conserve as much resources as possible, oncologists are asked to adopt the less expensive protocol for their patients. To determine the less expensive protocol, a cost minimization analysis was performed to compare the total cost of CAPOX versus FOLFOX protocols.
This study aims:
1. To calculate the total direct cost for both protocols.
2. To calculate the indirect costs for both protocols.
3. To perform sensitivity analysis to identify which resource utilization items, contribute more to the total cost.
4. To determine any statistically significant difference in the final cost of both protocols.
The study was conducted in the clinical oncology and nuclear medicine department of Alexandria Main University Hospital in Egypt. The hospital provides free services for nearly all the medical fields for the population of Alexandria and the nearby governorates. The study sample consisted of 60 medical records of patients treated for metastatic colorectal cancerduring the period from the 1st of July 2015 to the 30th of June 2017. 30 patient records from the CAPOX treated patients were included and an equal number of FOLFOX records was sampled using systemic random sampling technique.
A cost minimization analysis was conducted to calculate the total cost of both protocols. The final costs were calculated on a Microsoft Excel cost effectiveness model. Data about the patients was collected from patient records and from different departments in the hospital and introduced into the model. The included cost and utilization data covered the direct medical costs, direct non-medical costs and indirect costs associated with the protocol. The costs of the cycles were calculated from 2 perspectives; a public payer’s perspective and a societal perspective. Calculations for each revealed how much each protocol costs from the different perspectives.
Eight main cost factors were calculated in the model; cost of chemotherapeutic agents, cost of hospitalization, cost of medical supplies, cost of extra medications (associated with administration), cost of lab tests, cost of transportation (to and from the medical facility), cost of lost productivity and cost of side effects associated with each protocol. All the costs were added and an average cost for the whole protocol was calculated from each perspective.The cost of the two protocols was compared to reveal which protocol was more cost effective. Deterministic sensitivity analysis was conducted to show the extent by which the results would change if the cost factors changed and to show which cost factors have the greatest effect on the results.
The study revealed the following findings:
1.Direct medical and non-medical costs of FOLFOX protocol for treating metastatic colorectal cancer is higher than the direct medical and non-medical costs of CAPOX protocol by about 6000 EGP per patient.
2.from the perspective of the public payer, the direct costs of FOLFOX is more than the direct costs of CAPOX by about 5700 EGP per patient.
3.Costs of transportation to and from the medical facility in case of FOLFOX treated patients are much higher than the costs in case of CAPOX.
4. from a societal perspective, more resources are lost, and less productivity is achieved in case of FOLFOX treated patients compared to CAPOX.
5. Chemotherapeutic agents, hospitalization and costs of treating some side effects are the highest factors that affect the total cost of the protocols.
6. In general, CAPOX protocol seems to cost less than FOLFOX protocol from both perspectives and changing the inputs by 10% will not change these values significantly.
Based on the study findings, the following recommendations are suggested:
1.Consider using the more cost-effective protocol for patients who can bear taking oral drugs
2.Better documentation of side effects due to the chemotherapeutic protocols should be achieved through continuous pharmacovigilance.
3.Further research to calculate the average cost per patient for a larger sample size and better estimation for the side effects costs and their utilization