Cost effectiveness of treatment options in advanced breast cancer in the UK.
OBJECTIVE
To compare clinical and economic study data for docetaxel, paclitaxel and vinorelbine in the treatment of anthracycline-resistant advanced breast cancer.


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.


CONCLUSIONS
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 pound1995 per quality-adjusted life year (QALY) gained (1998 values). The incremental cost-utility ratio for docetaxel versus vinorelbine was pound14 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.
Brown
R E
RE
MEDTAP International, Inc., London, UK.
Hutton
J
J
Burrell
A
A
D000972:Antineoplastic Agents, Phytogenic / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000191:economics / Q000523:psychology; D003362:Cost-Benefit Analysis / Q000191:economics*; D003658:Decision Making, Computer-Assisted; D000077143:Docetaxel; D005260:Female; D006801:Humans; D017239:Paclitaxel / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D016879:Salvage Therapy / Q000191:economics*; D043823:Taxoids; D006113:United Kingdom; D014747:Vinblastine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D000077235:Vinorelbine
D000972:Antineoplastic Agents, Phytogenic; D043823:Taxoids; D000077143:Docetaxel; D014747:Vinblastine; D017239:Paclitaxel; D000077235:Vinorelbine