Journal Information
Vol. 33. Issue 5.
Pages 240-246 (January 2009)
Vol. 33. Issue 5.
Pages 240-246 (January 2009)
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Cost-reduction analysis for oral versus intravenous fludarabine (Beneflur®) in Spain
Análisis de minimización de costes de fludarabina (Beneflur®) oral vs. vía intravenosa en España
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Julio Delgadoa, Laia Febrerb, Diana Nievesc, Carme Piñolb, Max Brosac,
Corresponding author
max.brosa@oblikue.com

Corresponding author.
a Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
b Bayer Shering Pharma, Barcelona, Spain
c Oblikue Consulting, Barcelona, Spain
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Abstract
Introduction

Various international studies have shown that fludarabine is effective, safe, and efficient for treating B-cell chronic lymphocytic leukaemia (B-CLL). The purpose of the present study was to carry out a cost-minimization analysis for 2 alternative forms of fludarabine (oral and intravenous) used to treat B-CLL in Spain.

Methods

The presence of clinical evidence about the treatment equivalence of the 2 options being compared (oral fludarabine vs intravenous fludarabine) led us to carry out a costminimization analysis. A pharmacoeconomic model was constructed to compile data from the literature and experts’ opinions in order to determine the use of health resources associated with the treatment; unit costs were obtained from Spanish databases. The analysis contemplated 2 perspectives: that of the national health service, which includes only direct health costs, and the social perspective, which also includes the indirect costs that result from loss of productivity.

Results

Although fludarabine in its oral form has a higher purchase price than generic intravenous fludarabine does, increased administration costs for the latter, which is used in hospitals, mean that oral fludarabine use produces total savings of #euro1908 and #euro1292 for single-drug therapy and combined therapy with cyclophosphamide, respectively. Including indirect costs increased the savings associated with the oral form of the drug.

Conclusions

In B-CLL patients, treatment with oral fludarabine has a lower cost than treatment with intravenous fludarabine, in both single-drug therapy and combined therapy. Various sensitivity analyses confirmed these results and showed that oral fludarabine should be the treatment of choice for B-CLL in Spain, unless contraindicated.

Keywords:
Cost-minimization analysis
Oral fludarabine
Intravenous fludarabine
B-cell chronic lymphocytic leukaemia
Spaina
Resumen
Introducción

Fludarabina ha demostrado su eficacia, seguridad y eficiencia en el tratamiento de la leucemia linfocítica crónica de células B (LLC-B) en diversos estudios internacionales. El objetivo del presente estudio fue realizar un análisis de minimización de costes de 2 formas alternativas de fludarabina (oral e intravenosa) para el tratamiento de la LLC-B en España.

Métodos

La existencia de evidencias clínicas sobre la equivalencia terapéutica de las 2 opciones comparadas (fludarabina oral frente a fludarabina intravenosa) llevó a la realización de un análisis de minimización de costes. Se construyó un modelo farmacoeconómico que combinó datos de la bibliografía y la opinión de expertos para determinar el uso de recursos sanitarios asociados al tratamiento, y los costes unitarios se obtuvieron de bases de datos españolas. El análisis consideró 2 perspectivas: a) la del Sistema Nacional de Salud, que incluía sólo los costes directos sanitarios, y b) la perspectiva social, que además de éstos, incluía los costes indirectos derivados de la pérdida de productividad.

Resultados

Aunque la forma oral de fludarabina tiene un coste de adquisición mayor que la especialidad farmacéutica genérica de fludarabina intravenosa, los mayores costes de administración de esta última, de uso hospitalario, se tradujeron en unos ahorros totales asociados a fludarabina oral de 1.908 y 1.292 € en monoterapia y tratamiento combinado con ciclofosfamida, respectivamente. La inclusión de los costes indirectos aumentó los ahorros asociados a la forma oral.

Conclusiones

El tratamiento de los pacientes con LLC-B con fludarabina oral presenta unos costes menores respecto a fludarabina intravenosa, tanto en monoterapia, como en tratamiento combinado. Diversos análisis de sensibilidad confirmaron estos resultados, en los que se constata que la forma oral de fludarabina debería ser la opción de elección en el tratamiento de la LLC-B en España, salvo que se contraindique.

Palabras clave:
Análisis de minimización de costes
Fludarabina oral
Fludarabina intravenosa
Leucemia linfocítica crónica de células B
España
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