Cost-effectiveness of intensive adjuvant chemotherapy for high-risk breast cancer: is tailored and dose-escalated chemotherapy with growth factor support (GFS) more costly and less effective than marrow-supported high-dose chemotherapy - results from a randomized study.
Based on randomized studies bone-marrow supported (BMS) high-dose chemotherapy (HDCT) is not superior to conventional CT as adjuvant treatment for high-risk breast cancer. To compare the cost-effectiveness of these treatments we examined the data of Finnish patients in the SBG9401 trial 1. Patients were randomized to receive either dose-escalated (de FEC) (group A, n =59) or FEC and HDCT+BMS (group B, n =70). They received adjuvant radiotherapy (RT) + tamoxifen. All direct health care costs of first line treatment at the oncology units were considered as well as productivity costs within the first 3 years of follow-up. Effectiveness was measured by the number of survival days during 5 years of follow-up. The mean direct health care costs were significantly higher in group B (25829 euro in group A vs. 36605 euro in group B, p <0.001), mainly due to a higher number of hospital days. Half of the costs in group A was due to the use of filgrastim (15335 euro in A and 2969 euro in B, p <0.001). The costs of RT were only 5% of total costs. There was no statistically significant difference between the groups in the number of survival days, but sensitivity analysis based on bootstrapping suggested that treatment A would be a less costly and more effective alternative in a great majority of cases.
Kellokumpu-Lehtinen
P
P
Department of Oncology, Tampere University Hospital, Tampere, Finland. Pirkko-Liisa.Kellokumpu-Lehtinen@uta.fi
Bergh
J
J
Salminen
E
E
Wiklund
T
T
Lehtinen
S
S
Aronen
P
P
Sintonen
H
H
D000328:Adult; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D001853:Bone Marrow / Q000187:drug effects; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D017024:Chemotherapy, Adjuvant; D003362:Cost-Benefit Analysis; D005260:Female; D000069585:Filgrastim; D005387:Finland; D016179:Granulocyte Colony-Stimulating Factor / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D011994:Recombinant Proteins; D012306:Risk; D013534:Survival
D000970:Antineoplastic Agents; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D000069585:Filgrastim