title: Clinical and economic impact of epoetin in adjuvant-chemotherapy for breast cancer.
abstract: 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.
authors.affiliation: Department of Pharmacy, University Hospital of Besançon, Hospital J. MINJOZ, Boulevard Fleming, 25030, Besançon Cedex, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Fagnoni
authors.forename: Samuel
authors.initials: S
authors.lastname: Limat
authors.forename: Loïc
authors.initials: L
authors.lastname: Chaigneau
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Guardiola
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Briaud
authors.forename: Bernard
authors.initials: B
authors.lastname: Schmitt
authors.forename: Yacine
authors.initials: Y
authors.lastname: Merrouche
authors.forename: Xavier
authors.initials: X
authors.lastname: Pivot
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Woronoff-Lemsi
mesh_terms: 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
chemical_list: D015415:Biomarkers; D006397:Hematinics; D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin; D015251:Epirubicin; D000068817:Epoetin Alfa; D004317:Doxorubicin; D003520:Cyclophosphamide; D005472:Fluorouracil