Population-based pharmacoeconomic model for adopting capecitabine/docetaxel combination treatment for anthracycline-pretreated metastatic breast cancer.
OBJECTIVE
To model the cost-effectiveness of adopting capecitabine/docetaxel combination therapy in place of single-agent taxane therapy for women in the province of Ontario, Canada, receiving treatment for anthracycline-pretreated metastatic breast cancer.


METHODS
Clinical effectiveness and economic data were combined in a population model, from the perspective of a universal health care system. Estimates of clinical effectiveness and medical resource utilization were derived prospectively during a phase III randomized controlled trial comparing single-agent docetaxel with capecitabine/docetaxel combination therapy. Population data were obtained from the Cancer Care Ontario Registry and provincial prescription claims data.


RESULTS
During 1999-2000, 542 patients were eligible for taxane monotherapy. As capecitabine/docetaxel treatment confers a median 3-month survival benefit compared with docetaxel monotherapy, the projected survival gain in these patients was 136 life-years. The results of the cost-effectiveness analysis demonstrate that the survival benefit provided by the addition of capecitabine to single-agent docetaxel is afforded at a small incremental cost of Canadian $3,691 per life-year gained. Hospitalization costs for treatment of adverse events were less for patients receiving capecitabine/docetaxel combination therapy than for those receiving docetaxel monotherapy. The results were robust for adjustments in treatment costs and adverse effects costs.


CONCLUSIONS
Due to its 3-month survival gain and small incremental treatment cost, capecitabine/docetaxel is judged to be a highly cost-effective treatment in anthracycline-pretreated advanced breast cancer. From the perspective of the Ontario health care system, the addition of capecitabine to docetaxel in this patient population is a clinically appropriate and economically acceptable treatment strategy.
Verma
Shailendra
S
Ottawa Regional Cancer Centre, Ottawa, Ontario, Canada. shailendra.verma@orcc.on.ca
Ilersich
A Lane
AL
D000903:Antibiotics, Antineoplastic / Q000191:economics* / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000191:economics; D061067:Antibodies, Monoclonal, Humanized; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage* / Q000191:economics*; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage* / Q000191:economics*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D001952:Bridged-Ring Compounds / Q000008:administration & dosage / Q000191:economics; D002017:Budgets; D000069287:Capecitabine; D003362:Cost-Benefit Analysis / Q000191:economics; D003841:Deoxycytidine / Q000008:administration & dosage* / Q000031:analogs & derivatives* / Q000191:economics*; D000077143:Docetaxel; D004305:Dose-Response Relationship, Drug; D005260:Female; D005472:Fluorouracil / Q000031:analogs & derivatives; D005500:Follow-Up Studies; D006801:Humans; D009362:Neoplasm Metastasis; D009864:Ontario; D017239:Paclitaxel / Q000008:administration & dosage* / Q000031:analogs & derivatives* / Q000191:economics*; D011159:Population Surveillance; D016019:Survival Analysis; D043823:Taxoids; D000068878:Trastuzumab; D016896:Treatment Outcome; D014747:Vinblastine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics; D000077235:Vinorelbine; D016387:Women's Health
D000903:Antibiotics, Antineoplastic; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000964:Antimetabolites, Antineoplastic; D000972:Antineoplastic Agents, Phytogenic; D001952:Bridged-Ring Compounds; D043823:Taxoids; D003841:Deoxycytidine; D000077143:Docetaxel; C080625:taxane; D014747:Vinblastine; D000069287:Capecitabine; D000068878:Trastuzumab; D017239:Paclitaxel; D000077235:Vinorelbine; D005472:Fluorouracil