Posted on November 25, 2018

A graduate of Qatar University’s (QU) College of Pharmacy (CPH), Mr. Ahmad Amer Alkadour conducted a comparative economic evaluation between the oral chemotherapy ‘CAPOX’ and the IV chemotherapy ‘mFOLFOX6’ as the adjuvant treatments of chemotherapy for colorectal cancer (CRC) in Qatar in his master’s thesis which he defended last September, with the title The Pharmacoeconomics of CAPOX as Adjuvant Treatment of Colorectal Cancer Patients in Qatar.

Mr. Ahmad highlighted the positive cost-savings associated with oral chemotherapy over the intravenous (IV) chemotherapy for CRC in Qatar, taking into consideration clinical and quality of life outcomes of the medications. This study is in support of the recent 2018 changes in the policy of Hamad Medical Corporation (HMC), where the cost of ‘oral’ chemotherapies for non-Qataris is now covered by the state.

The oral chemotherapy CAPOX regimen (capecitabine, oxaliplatin) is considerably more expensive to purchase than the IV mFOLFOX6 (5-fluorouracil, leucovorin, oxaliplatin). CAPOX, however, is associated with lesser hospitalization and adverse drug reactions when compared to mFOLFOX6. Here, as a direct response to a request by decision makers at the National Center for Cancer Care and Research (NCCCR), which is a member of HMC, and in collaboration with their practitioners, Mr. Ahmad evaluated the cost-effectiveness of CAPOX versus mFOLFOX6 in the NCCCR. The evaluation assessed which of the two regimens costs less in overall per outcome, going beyond the acquisition costs of drugs to also evaluate the secondary costs associated with hospitalization and adverse events.

Mr. Ahmad noted that because of limited follow-up data, that covers long-term details of CRC patients in NCCCR, the comparative model of the study was simulation based, extracting data from a variety of resources. He says, “The simulation-based evaluation is the future of healthcare and is appropriate. The current study was based on a hypothetical cohort of 10,000 patients in Qatar. Economic, clinical and life quality data were obtained from medical records at NCCCR, published literature clinical trials, local databases as well as the expert opinions of NCCCR practitioners and decision makers.”

Mr. Ahmad added, “This analysis is the first pharmacoeconomics evaluation in Qatar and the region about cancer therapy. It also includes several methodological aspects that make it unique among similar studies in international settings.” The study illustrated the general dominance of CAPOX over mFOLFOX6 in all clinical, humanistic and economic aspects. CAPOX is expected to save QAR 130,395 per additional treated case of CRC, at least being more effective than mFOLFOX6 with a higher rate of disease-free survival (DFS) without adverse drug reactions. The dominance of CAPOX was maintained in 52.5% of cases in the cost per quality of life analysis and in 100% of cases in the cost per DFS analysis.

This study was conducted under the main supervision of CPH Associate Professor Daoud Al-Badriyeh, and is co-supervised by CPH Associate Professor Ahmed Awaisu. Dr. Al-Badriyeh said, “The project is timely and was conducted in parallel to the recent, and very important HMC shift in how the cost of oncology treatment is covered in Qatar. Important, is that the study results provide supporting evidence of these recent decisions, particularly that the cost of the more expensive CAPOX is now covered by the state and not the cancer patient anymore, which –as compared to not covering it– is of considerable overall cost-savings to HMC.”

Results of the study, Dr. Al-Badriyeh added, were presented locally to decision-makers and stakeholders in HMC, regionally at Oman’s Pharmaceutical Care Conference and internationally at International Society for Pharmacoeconomics and Outcomes Research Conference (ISPOR) in the United States of America.