This guidance is not expected to result in a net increase in NHS expenditure in England and Wales, because fludarabine is already in common use. Increases in drug acquisition costs are likely to be offset by the transfer to the oral formulation, and because the switch from combination therapies to fludarabine should reduce the costs of treating adverse side effects.
(a) For each patient already being treated with fludarabine, it can be expected that cost savings in drug administration in switching from intravenous to oral fludarabine will be about £2,300 per course of an average 4 cycles (there was an average of 4 cycles of oral fludarabine given in one of the key trials).
(b) For each patient new to fludarabine therapy who would otherwise have been prescribed combination chemotherapy (CHOP, CAP or CVP), the increased drug acquisition cost of fludarabine should be partially or fully offset by cost savings from avoiding the necessity of treating the side effects of combination drug therapy. For this group of patients, the net cost effect, on average, is likely to have a range of zero to £2,000, although this does not include the further costs of those who might subsequently also be treated with combination chemotherapy.
(c) For each patient new to fludarabine therapy who would not have been able to tolerate combination chemotherapy, the additional costs are likely to be of the order of £6,000 to £9,000 per patient.