Economics of Intravenous Fludarabine Phosphate and Oral Fludarabine Phosphate for the Treatment of B-Cell Chronic Lymphocytic Leukemia in a Developing Country - Brazil.

B-cell chronic lymphocytic leukemia (B-CLL) is the commonest leukemia occurring in Western countries, and arises predominantly in older age groups. Intravenous fludarabine phosphate offers the possibility of a prolonged progression-free interval, an increased response rate and a trend toward better tolerability in comparison with standard polychemotherapy regimens. A more convenient oral formulation of fludarabine phosphate, has been developed. We undertook a literature review that has demonstrated that oral fludarabine phosphate has a similar clinical efficacy and safety profile to the IV formulation and does not adversely affect quality of life. Also we performed a retrospective analysis of patients receiving IV fludarabine for (B-CLL) at our institution to determine the management and resource use of these patients. A cost minimization analysis was then conducted. The per patient costs for the treatment of drug-related adverse events were in local currence R$ 1.476,87 for oral fludarabine and R$ 2.119,64 for IV fludarabine. When costs of a full course of each treatment were compared, the costs per patient for oral fludarabine and IV fludarabine were R$ 22.152,43 and R$ 23.160,31 respectively. In this preliminary analysis, considering that oral fludarabine has a similar efficacy rate and tolerability profile to IV fludarabine, the oral formulation appeared to have a lower total cost per patient. These data require confirmation with formal assessment of cost-effectiveness.