Cost-utility analysis of 5-fluorouracil and capecitabine for adjuvant treatment in locally advanced rectal cancer

Colorectal cancer (CRC) is the third common cause of malignancy in the world. The incidence and death rate from this cancer has a trend increasingly, especially in developing countries (1). Chemotherapy and radiation therapy (RT) are considered as appropriated pre-operative and post-operative treatments for locally advanced rectal cancer (LARC), stage II (T3–4N0M0) and III (T1–4N1–2M0). Intravenous administration of 5-fluorouracil (5-FU)-based regimen or oral administration of fluoropyrimidine as capecitabine is commonly used in concurrent time with RT and adjuvant treatment. In 2012, a landmark study from Germany reported that capecitabine could be substituted for 5-FU in pre-operative or post-operative setting for rectal cancer because of its non-inferiority of efficacy and less hemato-toxicity than 5-FU (2). Therefore, capecitabine is proved to be used as an adjuvant setting in NCCN guideline for rectal cancer (3)