title: Adding docetaxel to cisplatin and fluorouracil in patients with unresectable head and neck cancer: a cost-utility analysis.
abstract: BACKGROUND
  Adding docetaxel (Taxotere, T) to induction chemotherapy with platinum/infusional 5-FU (PF) has been shown to improve overall survival of patients with head and neck cancer. The aim of the study was to analyze the cost-utility of TPF in patients with unresectable disease.
  
  
  METHODS
  We developed a Markov model to represent patient's weekly transitions among different health states, related to treatment or disease status. Transition probabilities were obtained from the TAX 324 clinical trial report and from the European Organization for Research and Treatment of Cancer (EORTC) 24971/TAX 323 raw data. Costs were estimated in Italy from a Regional Healthcare System perspective. A 5-year temporal horizon was adopted and a 3.5% yearly discount rate was applied.
  
  
  RESULTS
  When compared with PF, TPF treatment increases life expectancy by 0.33 quality-adjusted life-years (QALYs) in TAX 323 and 0.41 QALYs in TAX 324. The benefit was achieved at a cost of €11,822/QALY for TAX 323 and €6757/QALY for TAX 324. Monte Carlo sensitivity analysis showed that 69% (TAX 323) and 99% (TAX 324) of the results lie below the threshold of €50,000/QALY saved.
  
  
  CONCLUSIONS
  In our analysis, TPF induction chemotherapy proved to be cost-effective when compared with PF, having a cost-utility ratio comparable to other widely accepted healthcare interventions.
authors: Department of Internal Medicine, Azienda Ospedaliera della Provincia di Pavia, Casorate Primo, Italy. lucio_liberato@ospedali.pavia.it
authors: N L
authors: NL
authors: Liberato
authors: C
authors: C
authors: Rognoni
authors: S
authors: S
authors: Rubrichi
authors: S
authors: S
authors: Quaglini
authors: M
authors: M
authors: Marchetti
authors: T
authors: T
authors: Gorlia
authors: L
authors: L
authors: Licitra
authors: J B
authors: JB
authors: Vermorken
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000401:mortality; D002945:Cisplatin / Q000008:administration & dosage; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D000077143:Docetaxel; D005472:Fluorouracil / Q000008:administration & dosage; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000401:mortality; D060828:Induction Chemotherapy / Q000191:economics; D008390:Markov Chains; D009010:Monte Carlo Method; D016032:Randomized Controlled Trials as Topic; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D043823:Taxoids / Q000008:administration & dosage
chemical_list: D043823:Taxoids; D000077143:Docetaxel; D002945:Cisplatin; D005472:Fluorouracil