Docetaxel in combination with doxorubicin and cyclophosphamide as adjuvant treatment for early node-positive breast cancer: a cost-effectiveness and cost-utility analysis.
OBJECTIVE
To estimate the cost effectiveness of TAC (docetaxel, doxorubicin, and cyclophosphamide) compared with FAC (fluorouracil, doxorubicin, and cyclophosphamide) when administered as adjuvant therapy to women with node-positive early breast cancer in the United Kingdom (UK), both with and without primary prophylaxis with granulocyte colony-stimulating factor (G-CSF).


METHODS
A standard health economic Markov model estimated the cost and outcome for node-positive early breast cancer patients, from initiation of adjuvant chemotherapy to death. Patient-level data were used from the Breast Cancer International Research Group (BCIRG) 001 trial for estimates of the effect of chemotherapy on toxicity and outcome, and an observational data set collected from a UK university hospital provided estimates of resource use and outcome for patients with relapsed disease.


RESULTS
Over a 10-year analysis timeframe, the incremental cost per life-year saved associated with the use of TAC rather than FAC was estimated as pound 15,418 (95% CI, pound 13,734 to pound 17,997) and the incremental cost per quality-adjusted life-year gained (IC/QALY) was pound 18,188 (95% CI, pound 14,161 to pound 32,422). The addition of primary G-CSF (lenograstim or filgrastim) to the TAC regimen resulted in an IC/QALY of pound 20,432. The results were most sensitive to the quality-of-life (QOL) score for patients in remission postchemotherapy. However, even if QOL was assumed to be as poor as for patients with metastatic disease, the IC/QALY estimate rose only to pound 32,430.


CONCLUSIONS
The use of adjuvant TAC rather than FAC for node-positive early breast cancer patients is cost effective, despite the increased drug and toxicity treatment costs, and when primary G-CSF prophylaxis is given to all patients.
Wolowacz
Sorrel E
SE
RTI-Health Solutions, Williams House, University of Manchester Science Park, Manchester M15 6SE, United Kingdom. swolowacz@rti.org
Cameron
David A
DA
Tate
Helen C
HC
Bagust
Adrian
A
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D001365:Axilla; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000473:pathology / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003362:Cost-Benefit Analysis; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000191:economics; D003663:Decision Trees; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage / Q000191:economics; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000191:economics; D016179:Granulocyte Colony-Stimulating Factor / Q000191:economics* / Q000627:therapeutic use*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008390:Markov Chains; D009367:Neoplasm Staging; D009503:Neutropenia / Q000139:chemically induced / Q000517:prevention & control*; D020011:Protective Agents / Q000191:economics / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D043823:Taxoids / Q000008:administration & dosage / Q000191:economics; D006113:United Kingdom
D020011:Protective Agents; D043823:Taxoids; D016179:Granulocyte Colony-Stimulating Factor; D004317:Doxorubicin; D003520:Cyclophosphamide; D005472:Fluorouracil