Cost effectiveness of TAC versus FAC in adjuvant treatment of node-positive breast cancer (original) (raw)
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Annals of Oncology, 2010
Background: Using data from the PACS 01 randomized trial, we evaluated the cost-effectiveness of anthracyclines plus docetaxel (Taxotere; FEC-D) versus anthracyclines alone (FEC100) in patients with node-positive breast cancer. Patients and methods: Costs and outcomes were assessed in 1996 patients and the incremental costeffectiveness ratios (ICERs) were estimated, using quality-adjusted life years (QALYs) as outcome. To deal with uncertainty due to sampling fluctuations, confidence regions around the ICERs were calculated and cost-effectiveness acceptability curves were drawn up. Sensitivity analyses were also carried out to assess the robustness of conclusions. Results: The mean cost of treatment was 33% higher with strategy FEC-D, but this difference decreased to 18% at a 5-year horizon. The ICER of FEC-D versus FEC100 was estimated to be 9665€ per QALY gained (95% confidence interval €2372-€55 515). The estimated probability that FEC-D was cost-effective reached >96% for a threshold of €50 000 per QALY gained. If the price of taxane decreased slightly, the ICER would reach some very reasonable levels and this strategy would therefore be much more cost-effective. Conclusion: The sequential use of FEC100 followed by docetaxel appears to be a cost-effective alternative, even when uncertainty is taken into account.
European Journal of Clinical Pharmacology, 1996
Recently, the National Surgical Adjuvant Study of Colorectal Cancer in Japan, a randomised controlled trial of oral uracil-tegafur (UFT) adjuvant therapy for stage III rectal cancer, showed remarkable survival gains, compared with surgery alone. To evaluate value for money of adjuvant UFT therapy, cost-effective analysis was carried out. Cost-effectiveness analysis of adjuvant UFT therapy was carried out from a payer's perspective, compared with surgery alone. Overall survival and relapse-free survival were estimated by Kaplan-Meier method, up to 5.6 years from randomisation. Costs were estimated from trial data during observation. Qualityadjusted life-years (QALYs) were calculated using utility score from literature. Beyond observation period, they were simulated by the Boag model combined with the competing risk model. For 5.6-year observation, 10-year follow-up and over lifetime, adjuvant UFT therapy gained 0.50, 0.96 and 2.28 QALYs, and reduced costs by 2457,2457, 2457,1771 and $1843 per person compared with surgery alone, respectively (3% discount rate for both effect and costs). Cost-effectiveness acceptability and net monetary benefit analyses showed the robustness of these results. Economic evaluation of adjuvant UFT therapy showed that this therapy is cost saving and can be considered as a cost-effective treatment universally accepted for wide use in Japan.
European Journal of Cancer, 2011
Early breast cancer Chemotherapy A B S T R A C T Background: The risk of recurrence following surgery in women with early breast cancer varies, depending upon prognostic factors. Adjuvant chemotherapy reduces this risk; however, increasingly effective regimens are associated with higher costs and toxicity profiles, making it likely that different regimens may be cost-effective for women with differing prognoses. To investigate this we performed a cost-effectiveness analysis of four treatment strategies: (1) no chemotherapy, (2) chemotherapy using cyclophosphamide, methotrexate, and fluorouracil (CMF) (a first generation regimen), (3) chemotherapy using Epirubicin-CMF (E-CMF) or fluorouracil, epirubicin, and cyclophosphamide (FEC60) (a second generation regimens), and (4) chemotherapy with FEC60 followed by docetaxel (FEC-D) (a third generation regimen). These adjuvant chemotherapy regimens were used in three large UK-led randomised controlled trials (RCTs). Methods: A Markov model was used to simulate the natural progression of early breast cancer and the impact of chemotherapy on modifying this process. The probability of a first recurrent event within the model was estimated for women with different prognostic risk profiles using a parametric regression-based survival model incorporating established 0959-8049/$ -see front matter Ó 4 7 ( 2 0 1 1 ) 2 5 1 7 -2 5 3 0 a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e j c o n l i n e . c o m prognostic factors. Other probabilities, treatment effects, costs and quality of life weights were estimated primarily using data from the three UK-led RCTs, a meta-analysis of all relevant RCTs, and other published literature. The model predicted the lifetime costs, quality adjusted life years (QALYs) and cost-effectiveness of the four strategies for women with differing prognoses. Sensitivity analyses investigated the impact of uncertain parameters and model assumptions.
Onkologie, 2009
Kostenanalyse · Docetaxel · Ressourcen · Mammakarzinom · Adjuvante Chemotherapie Zusammenfassung Hintergrund: Die Standardtherapie des nodal-positiven primären Mammakarzinoms bilden heute Taxan-haltige Regime. In aktuellen Studien konnten jedoch größere Patientensubgruppen identifiziert werden, die möglicherweise von dieser Therapie nicht profitieren. Um die mit der Einführung Taxan-basierter Chemotherapien verbundene Steigerung des Ressourcenverbrauchs und der Kosten abschätzen zu können, verglichen wir ein modernes sequentielles Regime (4× Epirubicin/Cyclophosphamid; 4× Docetaxel: EC→DOC) mit der kostengünstigen CMF-Therapie. Patienten und Methoden: Die Datenerhebung erfolgte parallel zur Phase-III-WSG-AGO- Intergroup-Studie (2000. Eine Kohorte von 110 Patientinnen mit 1047 Chemotherapiezyklen an 38 Studienzentren wurde aus der Perspektive des Krankenhauses analysiert. Ergebnisse: Das durchschnittliche Alter betrug 52,4 Jahre. Die durchschnittlichen Kosten für eine EC→DOC Therapie (n = 54) beliefen sich auf € 8459 pro Patientin (95% confidence interval (CI): € 7785-9132). Hiervon verursachten die reinen Zytostatikakosten den größten Anteil. CMF war im Vergleich signifikant (-41,2%) kostengünstiger (€ 4973; 95% CI: € 4706-5240). Gleichzeitig konnte im CMF-Kollektiv die Anzahl toxizitätsassoziierter Krankenhausaufenthalte halbiert werden (CMF: n = 4, EC→DOC: n = 8). Schlussfolgerungen: Unsere Ergebnisse beschreiben eine substantielle Kostensteigerung, die die Einführung von sequentiellem Docetaxel in die adjuvante Chemotherapie des Mammakarzinoms nach sich zieht. Die vorgestellten Daten können zukünftig zur Ermittlung der Kosteneffektivität individualisierter Chemotherapiestrategien herangezogen werden.
Journal of Research in Medical Sciences
in the Europe Union countries in 2009, was estimated at over 133 billion Euros. [7] Among women, breast cancer is the main cause of disease and death. Each year billions of dollars are spent on treating breast cancer. [8-10] In Iran, breast cancer is most frequently identified among other cancer that are diagnosed in women. [11] Cancer chemotherapy is vital for patients with cancer. However, the available cancer treatments are usually very expensive. This situation not only threatens the lives and well-being of cancer patients but also jeopardize their financial security. [12] Most women with locally advanced breast cancer cannot be treated surgically. Hence, neoadjuvant chemotherapy can be used for women with locally advanced breast cancer. [13] The tendency to use neoadjuvant chemotherapy has increased due to its Background: A decision analysis model was developed to assess the cost-effectiveness of adriamycin and cyclophosphamide (AC) in comparison with paclitaxel and gemcitabine (PG) in women with advanced breast cancer in Iran. Materials and Methods: This is a cost-effectiveness analysis performed as a cross-sectional study in Namazi Hospital in Shiraz, Iran. Patients were divided into two groups by random numbers, 32 women in the AC group and 32 women in the PG group. The costs were measured using the societal perspective and effectiveness of 2 regimens were assessed using tumor response. By a decision tree, the incremental cost-effectiveness ratio was calculated. In addition, the robustness of results was examined by sensitivity analysis. Results: The estimated total cost of AC and PG per patient was 1565.23 ± 765.31 and 2099.08 ± 926.99, respectively. Response to treatment in AC and PG arm were 84% versus 75% respectively. The incremental cost-effectiveness ratio results showed AC is a dominate alternative. Conclusion: Overall, AC was a simple dominate strategy. In other words, AC was estimated to have a lower cost and greater effectiveness than PG.
A Canadian economic analysis of U.S. Oncology Adjuvant Trial 9735
Current oncology (Toronto, Ont.), 2011
Recent results of the U.S. Oncology Adjuvant Trial 9735 demonstrated significant disease-free survival and overall survival benefits for docetaxel and cyclophosphamide (tc) compared with doxorubicin and cyclophosphamide (ac) in the adjuvant treatment of operable invasive breast cancer. Based on clinical data from the 9735 study, we evaluated the lifetime cost-effectiveness of tc compared with ac from the perspective of the Canadian publicly funded health care system. A Markov model was developed to estimate the incremental cost per quality-adjusted life-year gained and per life-year gained. Monthly survival and risk of disease recurrence up to 7 years were obtained directly from the overall survival and disease-free survival curves in the 9735 study; life-years beyond 7 years were estimated using the average life expectancy of age-matched women in the general Canadian population. Canadian-specific resource utilization and unit costs (in 2008 Canadian dollars) were applied to estimat...
Value in Health Regional Issues
Objectives: Transferability of economic evaluations to low-and middleincome countries through adaptation of models is important; however, several methodological and practical challenges remain. Given its significant costs and the quality-of-life burden to patients, adjuvant treatment of early breast cancer was identified as a priority intervention by the South African National Department of Health. This study assessed the cost-effectiveness of docetaxel and paclitaxel-containing chemotherapy regimens (taxanes) compared with standard (nontaxane) treatments. Methods: A cost-utility analysis was undertaken based on a UK 6-health-state Markov model adapted for South Africa using the Mullins checklist. The analysis assumed a 35-year time horizon. The model was populated with clinical effectiveness data (hazard ratios, recurrence rates, and adverse events) using direct comparisons from clinical trials. Resource use patterns and unit costs for estimating cost parameters (drugs, diagnostics, consumables, personnel) were obtained from South Africa. Uncertainty was assessed using probabilistic and deterministic sensitivity analyses. Results: The incremental cost per patient for the docetaxel regimen compared with standard treatment was R6774. The incremental quality-adjusted life years (QALYs) were 0.24, generating an incremental cost-effectiveness ratio of R28430 per QALY. The cost of the paclitaxel regimen compared with standard treatment was estimated as ÀR578 and ÀR1512, producing an additional 0.03 and 0.025 QALYs, based on 2 trials. Paclitaxel, therefore, appears to be a dominant intervention. The base case results were robust to all sensitivity analyses. Conclusions: Based on the adapted model, docetaxel and paclitaxel are predicted to be costeffective as adjuvant treatment for early breast cancer in South Africa.
A Cost-Utility Analysis of Second-Line Chemotherapy in Metastatic Breast Cancer
PharmacoEconomics, 1996
Although Metastatic Breast Cancer (MBC) is a major public health issue no economic evaluations of cancer therapy have been published for first and second line treatments. A full economic evaluation examining both the costs and consequences of medical care will enable clinicians to optimise their choice of management.
Cost Effectiveness of Treatment Options in Advanced Breast Cancer in the UK
PharmacoEconomics, 2001
Objective: To compare clinical and economic study data for docetaxel, paclitaxel and vinorelbine in the treatment of anthracycline-resistant advanced breast cancer. Study design and methods: A Markov decision-analysis model to simulate the clinical course of a 'typical' patient with advanced breast cancer during salvage chemotherapy was updated with response rates and adverse effect rates from phase III clinical trial data for docetaxel, paclitaxel and vinorelbine. Costs were taken from UK national databases and hospitals. Utilities were estimated from 30 oncology nurses in the UK using the standard gamble method. Perspective: National Health Service. Results: When compared with other chemotherapeutic agents, docetaxel has been shown to increase response rate, time to progression and survival in patients with advanced breast cancer. In the base-case analysis, the incremental cost-utility ratio for docetaxel versus paclitaxel was £1995 per quality-adjusted life year (QALY) gained (1998 values). The incremental cost-utility ratio for docetaxel versus vinorelbine was £14 055 per QALY gained. In the comparison with vinorelbine, docetaxel provided the equivalent of an additional 92 days of perfect health. Sensitivity analyses confirmed the robustness of the model and the validity of the base-case analysis results. Even in the worst case scenarios, docetaxel remained cost effective compared with paclitaxel and vinorelbine. Conclusions: These findings support the use of the taxoids, notably docetaxel, in the management of advanced breast cancer.