title: Economic analysis of conventional-dose chemotherapy compared with high-dose chemotherapy plus autologous hematopoietic stem-cell transplantation for metastatic breast cancer.
abstract: We performed an economic analysis of data from 180 women in a clinical trial of conventional-dose chemotherapy vs high-dose chemotherapy plus stem-cell transplantation for metastatic breast cancer responding to first-line chemotherapy. Data on resource use, including hospitalizations, medical procedures, medications, and diagnostic tests, were abstracted from subjects' clinical trial records. Resources were valued using the Medicare Fee Schedule for inpatient costs at one academic medical center and average wholesale prices for medications. Monthly costs were calculated and stratified by treatment group and clinical phase. Mean follow-up was 690 days in the transplantation group and 758 days in the conventional-dose chemotherapy group. Subjects in the transplantation group were hospitalized for more days (28.6 vs 17.8, P=0.0041) and incurred higher costs (US dollars 84055 vs US dollars 28169) than subjects receiving conventional-dose chemotherapy, with a mean difference of US dollars 55886 (95% CI, US dollars 47298-US dollars 63666). Sensitivity analyses resulted in cost differences between the treatment groups from US dollars 36528 to US dollars 75531. High-dose chemotherapy plus stem-cell transplantation resulted in substantial additional morbidity and costs at no improvement in survival. Neither the survival results nor the economic findings support the use of this procedure outside of the clinical trial setting.
authors.affiliation: Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27715, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Schulman
authors.forename: E A
authors.initials: EA
authors.lastname: Stadtmauer
authors.forename: S D
authors.initials: SD
authors.lastname: Reed
authors.forename: H A
authors.initials: HA
authors.lastname: Glick
authors.forename: L J
authors.initials: LJ
authors.lastname: Goldstein
authors.forename: J M
authors.initials: JM
authors.lastname: Pines
authors.forename: J A
authors.initials: JA
authors.lastname: Jackman
authors.forename: S
authors.initials: S
authors.lastname: Suzuki
authors.forename: M J
authors.initials: MJ
authors.lastname: Styler
authors.forename: P A
authors.initials: PA
authors.lastname: Crilley
authors.forename: T R
authors.initials: TR
authors.lastname: Klumpp
authors.forename: K F
authors.initials: KF
authors.lastname: Mangan
authors.forename: J H
authors.initials: JH
authors.lastname: Glick
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000191:economics / Q000473:pathology / Q000628:therapy*; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D004305:Dose-Response Relationship, Drug; D004469:Economics, Hospital; D005260:Female; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis; D018579:Patient Selection; D015203:Reproducibility of Results; D033581:Stem Cell Transplantation / Q000191:economics*; D014481:United States
chemical_list: D000970:Antineoplastic Agents