Guidance on the use of capecitabine and tegafur with uracil for metastatic colorectal cancer

Given the available evidence, a conservative estimate of the cost savings that would be associated with all individuals receiving capecitabine instead of bolus 5-FU/FA is £10.5 million, including VAT. This is based on the assumption that 7,000 people receive capecitabine (costing £2,100 per person as estimated by the assessment group) instead of bolus Mayo 5-FU/FA (costing £3,600 per person as estimated by the assessment group). The savings would be similar if it is assumed that capecitabine is used in preference to the modified de Gramont regimen (costing £3,500 per person as estimated by the assessment group). However, this estimated cost saving is higher if the calculations are based on the assumption that people would otherwise receive the de Gramont infusional regimen 5-FU/FA (costing £6,250 per person as estimated by the assessment group) or on the manufacturer's cost estimates.

If it is assumed that 7,000 people receive UFT/FA (costing £3,400 per person as estimated by the assessment group) instead of 5-FU/FA administered using the Mayo or modified de Gramont outpatient-based regimen, there could be savings of up to £1.4 million. However, if 7,000 people receive UFT/FA instead of the unmodified de Gramont infusion regimen, there could be a reduction in costs of nearly £20 million.

However, it is unlikely that such savings would be realised in terms of 'cash' for 2 reasons: the estimates represent amounts of resources that would remain within the system (but might nevertheless be redeployed); and the estimates are based on average costs (for example, of days in hospital avoided), some of which are fixed costs and therefore will not be saved, but could be available for other purposes.