Clinical and economic impact of epoetin in adjuvant-chemotherapy for breast cancer.
BACKGROUND
Anaemia is a common toxicity in cancer patients and epoetins (EPOs) are now an established treatment. The economic profile of EPO treatment was assessed in patients with breast cancer treated by adjuvant-chemotherapy.


METHODS
Two strategies were compared: without treatment by EPO and with the possible use of treatment by EPO (epoetin alfa) when required. The clinical effectiveness criterion was time adjusted to quality of life and economic data included only direct medical costs.


RESULTS
One hundred ninety-two patients were included. In the group with the strategy containing the possible use of EPO, 45.5% of patients effectively received EPO. A significant difference in the haemoglobin level profile over time was observed which provided a significant overall benefit of 0.0052 (p<10(-4)) quality-adjusted life year (QALY) associated with an extra cost of <euro>1,615 (p<10(-4)). In the base case analysis, the cost per added QALY was estimated as <euro>310,577 with the strategy containing the possible use of EPO.


CONCLUSIONS
This robust result seems to be unacceptable, but the only relevant point of discussion might be the level of acceptable incremental cost-effectiveness ratio (ICER) for a patient.
Fagnoni
Philippe
P
Department of Pharmacy, University Hospital of Besançon, Hospital J. MINJOZ, Boulevard Fleming, 25030, Besançon Cedex, France.
Limat
Samuel
S
Chaigneau
Loïc
L
Guardiola
Emmanuel
E
Briaud
Stéphanie
S
Schmitt
Bernard
B
Merrouche
Yacine
Y
Pivot
Xavier
X
Woronoff-Lemsi
Marie-Christine
MC
D000328:Adult; D000368:Aged; D000740:Anemia / Q000139:chemically induced / Q000188:drug therapy* / Q000191:economics*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000191:economics*; D017024:Chemotherapy, Adjuvant; D003362:Cost-Benefit Analysis; D003520:Cyclophosphamide / Q000009:adverse effects; D004317:Doxorubicin / Q000009:adverse effects; D015251:Epirubicin / Q000009:adverse effects; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000191:economics* / Q000627:therapeutic use*; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects; D005602:France; D006397:Hematinics / Q000191:economics / Q000627:therapeutic use; D006454:Hemoglobins / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D008875:Middle Aged; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D011994:Recombinant Proteins; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D015415:Biomarkers; D006397:Hematinics; D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin; D015251:Epirubicin; D000068817:Epoetin Alfa; D004317:Doxorubicin; D003520:Cyclophosphamide; D005472:Fluorouracil