Can sequential administration minimise the cost of high dose chemotherapy? An economic assessment in inflammatory breast cancer.
OBJECTIVE
To evaluate the potential cost savings of using sequential high dose chemotherapy (HDC), with granulocyte colony-stimulating factor (filgrastim) and stem cell support, rather than single course administration of HDC with bone marrow transplantation (BMT) or peripheral blood stem cell transplantation (PBSCT).


CONCLUSIONS
French public hospital perspective.


METHODS
Direct medical costs of sequential treatment, estimated on the basis of physical quantities of resources consumed by 95 patients with inflammatory breast cancer (IBC) included in a French pilot multicentric trial (PEGASE 02), were compared with those of historical control groups of patients treated with single course HDC, either with BMT (n = 27) or PBSCT (n = 14). Costs were evaluated in 1998 French francs (1 Euro = 6.55957 French francs).


RESULTS
The total cost of sequential HDC was significantly lower than that for single course HDC both with BMT (-29%; 22,755 Euros vs 32,284 Euros; p < 0.001) or PBSCT (-16%; 22,755 Euros vs 27,209 Euros; p = 0.026). This was mainly due to a reduction in the length of hospitalisation in transplantation units.


CONCLUSIONS
According to our results, economic arguments cannot be used against the widespread use of sequential HDC for patients with IBC. However, further economic evaluations based on overall and disease-free survivals alongside a randomised clinical trial are still needed to definitively establish the cost effectiveness of sequential administration of HDC.
Marino
Patricia
P
Inserm Research Unit 379, Marseille, France. marino@marseille.inserm.fr
Le Corroller
Anne-Gaelle
AG
Palangié
Thao
T
Janvier
Maud
M
Fabbro
Michel
M
Molinier
Laurent
L
Delozier
Thierry
T
Livartowski
Alain
A
Moatti
Jean-Paul
JP
Viens
Patrice
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation / Q000191:economics; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000601:surgery; D003131:Combined Modality Therapy; D017046:Cost Savings; D004180:Direct Service Costs / Q000706:statistics & numerical data*; D004334:Drug Administration Schedule; D016527:Drug Costs / Q000706:statistics & numerical data*; D005260:Female; D000069585:Filgrastim; D005602:France; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage* / Q000191:economics*; D006779:Hospitals, Public / Q000191:economics; D006801:Humans; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000191:economics; D011994:Recombinant Proteins
D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D000069585:Filgrastim