title: Economic analysis of the TAX 317 trial: docetaxel versus best supportive care as second-line therapy of advanced non-small-cell lung cancer.
abstract: OBJECTIVE
  To determine the cost-effectiveness (CE) of second-line docetaxel compared with best supportive care (BSC) in the TAX 317 trial, a randomized clinical trial of second-line chemotherapy in non-small-cell lung cancer.
  
  
  METHODS
  A retrospective CE analysis of the TAX 317 trial was undertaken, evaluating direct medical costs of therapy from the viewpoint of Canada's public health care system. Costs were derived in 1999 Canadian dollars, and resource use was determined through prospective trial data.
  
  
  RESULTS
  The incremental survival benefit in the docetaxel arm over BSC was 2 months (P =.047). The CE of docetaxel was $57,749 per year of life gained. For patients treated with docetaxel 75 mg/m(2), the CE was $31,776 per year of life gained. In univariate sensitivity analyses, CE estimates were most sensitive to changes in survival, ranging from $18,374 to $117,434 with 20% variation in survival at the recommended dose. The largest cost center in both arms was hospitalization, followed by the cost of drugs, investigations, radiotherapy, and community care. BSC patients had fewer hospitalizations than patients in the chemotherapy arm and were more often palliated at home.
  
  
  CONCLUSIONS
  Although the decision to treat should not be based on economic considerations alone, our CE estimate of $31,776 per year of life gained (at the currently recommended dose of docetaxel) is within an acceptable range of health care expenditures, and the total costs of therapy are similar to those of second-line palliative chemotherapy for other solid tumors.
authors.affiliation: Department of Medical Oncology, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada. Natasha.Leigh@uhn.on.ca
authors.forename: Natasha B
authors.initials: NB
authors.lastname: Leighl
authors.forename: Frances A
authors.initials: FA
authors.lastname: Shepherd
authors.forename: Rita
authors.initials: R
authors.lastname: Kwong
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Burkes
authors.forename: Ronald
authors.initials: R
authors.lastname: Feld
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Goodwin
mesh_terms: D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use*; D002170:Canada; D002289:Carcinoma, Non-Small-Cell Lung / Q000191:economics / Q000628:therapy*; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D000077143:Docetaxel; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008175:Lung Neoplasms / Q000191:economics / Q000628:therapy*; D017239:Paclitaxel / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D010166:Palliative Care / Q000191:economics; D011878:Radiotherapy / Q000191:economics; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D043823:Taxoids
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D043823:Taxoids; D000077143:Docetaxel; D017239:Paclitaxel