Cost-effectiveness of adjuvant docetaxel for node-positive breast cancer patients: results of the PACS 01 economic study.
BACKGROUND
Using data from the PACS 01 randomized trial, we evaluated the cost-effectiveness of anthracyclines plus docetaxel (Taxotere; FEC-D) versus anthracyclines alone (FEC100) in patients with node-positive breast cancer.


METHODS
Costs and outcomes were assessed in 1996 patients and the incremental cost-effectiveness ratios (ICERs) were estimated, using quality-adjusted life years (QALYs) as outcome. To deal with uncertainty due to sampling fluctuations, confidence regions around the ICERs were calculated and cost-effectiveness acceptability curves were drawn up. Sensitivity analyses were also carried out to assess the robustness of conclusions.


RESULTS
The mean cost of treatment was 33% higher with strategy FEC-D, but this difference decreased to 18% at a 5-year horizon. The ICER of FEC-D versus FEC100 was estimated to be 9665euro per QALY gained (95% confidence interval euro2372-euro55 515). The estimated probability that FEC-D was cost-effective reached >96% for a threshold of euro50 000 per QALY gained. If the price of taxane decreased slightly, the ICER would reach some very reasonable levels and this strategy would therefore be much more cost-effective.


CONCLUSIONS
The sequential use of FEC100 followed by docetaxel appears to be a cost-effective alternative, even when uncertainty is taken into account.
Marino
P
P
Institut National pour la Santé et la Recherche médicale, unité 912, Marseille; Aix-Marseille Université, Marseille. Electronic address: patricia.marino@inserm.fr.
Siani
C
C
Research Center in Knowledge Engineering (ERIC, EA3083), University of Lyon (University Claude Bernard Lyon 1), Lyon.
Roché
H
H
Institut Claudius Régaud, Toulouse.
Protière
C
C
Institut National pour la Santé et la Recherche médicale, unité 912, Marseille; Aix-Marseille Université, Marseille.
Fumoleau
P
P
Centre Georges-François Leclerc, Dijon.
Spielmann
M
M
Institut Gustave Roussy, Villejuif.
Martin
A-L
AL
Fédération Nationale des Centres de Lutte Contre le Cancer, Paris.
Viens
P
P
Institut Paoli-Calmettes, Marseille, France.
Le Corroller Soriano
A-G
AG
Institut National pour la Santé et la Recherche médicale, unité 912, Marseille; Aix-Marseille Université, Marseille.
D000328:Adult; D000368:Aged; D018943:Anthracyclines / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D003362:Cost-Benefit Analysis; D000077143:Docetaxel; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008875:Middle Aged; D018803:Models, Economic; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D019057:Quality-Adjusted Life Years; D015996:Survival Rate; D043823:Taxoids / Q000008:administration & dosage; D016896:Treatment Outcome
D018943:Anthracyclines; D043823:Taxoids; D000077143:Docetaxel