Economic impact of simplified de Gramont regimen in first-line therapy in metastatic colorectal cancer.

The cost of chemotherapy has dramatically increased in advanced colorectal cancer patients, and the schedule of fluorouracil administration appears to be a determining factor. This retrospective study compared direct medical costs related to two different de Gramont schedules (standard vs. simplified) given in first-line chemotherapy with oxaliplatin or irinotecan. This cost-minimization analysis was performed from the French Health System perspective. Consecutive unselected patients treated in first-line therapy by LV5FU2 de Gramont with oxaliplatin (Folfox regimen) or with irinotecan (Folfiri regimen) were enrolled. Hospital and outpatient resources related to chemotherapy and adverse events were collected from 1999 to 2004 in 87 patients. Overall cost was reduced in the simplified regimen. The major factor which explained cost saving was the lower need for admissions for chemotherapy. Amount of cost saving depended on the method for assessing hospital stay. In patients treated by the Folfox regimen the per diem and DRG methods found cost savings of Euro 1,997 and Euro 5,982 according to studied schedules; in patients treated by Folfiri regimen cost savings of Euro 4,773 and Euro 7,274 were observed, respectively. In addition, travel costs were also reduced by simplified regimens. The robustness of our results was showed by one-way sensitivity analyses. These findings demonstrate that the simplified de Gramont schedule reduces costs of current first-line chemotherapy in advanced colorectal cancer. Interestingly, our study showed several differences in costs between two costing approaches of hospital stay: average per diem and DRG costs. These results suggested that standard regimen may be considered a profitable strategy from the hospital perspective. The opposition between health system perspective and hospital perspective is worth examining and may affect daily practices. In conclusion, our study shows that the simplified de Gramont schedule in combination with oxaliplatin or irinotecan is an attractive option from the French Health System perspective. This safe and less costly regimen must compared to alternative options such as oral fluoropyrimidines.

[Prevention of preparation errors of cytotoxic drugs in centralized units: from epidemiology to quality assurance]. / Maîtrise des erreurs de préparation des médicaments anticancéreux en unité centralisée: de l'épidémiologie à l'assurance qualité.

The centralized preparation of cytotoxic drugs is supposed to help preventing medication errors. Nevertheless, the residual risk of preparation errors has been demonstrated. Above all, prevention is based on the quality assurance policy. Following a previous work, this study valuates the effectiveness of a quality assurance policy and the impact of corrective actions. The study compares the rates of preparation errors observed before and after the corrective actions. The risk factors have also been studied. The study included 84,017 consecutive preparations. The results showed a significant reduction of overall (0.2% versus 0.4%) and major (0.1% versus 0.2%) errors between the two periods. This period impact has been validated by a multivariate analysis (OR were respectively 0.49 and 0.6, p < 10(-3)). The daily workload (> 60 preparations) appeared to be the most important risk factor (OR were respectively 2.4 and 3.2, p < or = 10(-3)). These results demonstrated the effectiveness of simple corrective actions. The follow-up on preparation errors appeared to be useful to raise technicians' awareness and to motivate them. An epidemiological approach allows to identify risk factors, and to definite relevant corrective actions.