title: An Italian cost-effectiveness analysis of paclitaxel albumin (nab-paclitaxel) versus conventional paclitaxel for metastatic breast cancer patients: the COSTANza study.
abstract: OBJECTIVE
  Paclitaxel albumin (nab-paclitaxel) is a nanoparticle albumin-bound paclitaxel formulation aimed at increasing therapeutic index in metastatic breast cancer. When compared to conventional paclitaxel, nab-paclitaxel has a reported longer time to progression, higher response, lower incidence of neutropenia, no need for premedication, shorter time of administration, and in pretreated metastatic breast cancer patients, extended overall survival. This study investigates the cost-effectiveness of nab-paclitaxel versus conventional paclitaxel for pretreated metastatic breast cancer patients in Italy.
  
  
  METHODS
  A Markov model with progression-free, progressed, and dead states was developed to estimate costs, outcomes, and quality adjusted life years over 5 years from the Italian National Health Service viewpoint. Patients were assumed to receive nab-paclitaxel 260 mg/m(2) three times weekly or conventional paclitaxel 175 mg/m(2) three times weekly. Data on health care resource consumption was collected from a convenience sample of five Italian centers. Resources were valued at Euro (€) 2011. Published utility weights were applied to health states to estimate the impact of response, disease progression, and adverse events on quality adjusted life years. Three sensitivity analyses tested the robustness of the base case incremental cost-effectiveness ratio (ICER).
  
  
  CONCLUSIONS
  Compared to conventional paclitaxel, nab-paclitaxel gains an extra 0.165 quality adjusted life years (0.265 life years saved) and incurs additional costs of €2506 per patient treated. This translates to an ICER of €15,189 (95% confidence interval: €11,891-€28,415). One-way sensitivity analysis underscores that ICER for nab-paclitaxel remains stable despite varying taxanes cost. Threshold analysis shows that ICER for nab-paclitaxel exceeds €40,000 only if cost per mg of conventional paclitaxel is set to zero. Probabilistic sensitivity analysis highlights that nab-paclitaxel has a 0.99 probability to be cost-effective for a threshold value of €40,000 and is the optimal alternative from a threshold value of €16,316 onwards. Based on these findings, nab-paclitaxel can be considered highly cost-effective when compared to the acceptability range for ICER proposed by the Italian Health Economics Association (€25,000-€40,000).
authors.affiliation: Studio di Economia Sanitaria, Milan, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Lazzaro
authors.forename: Roberto
authors.initials: R
authors.lastname: Bordonaro
authors.forename: Francesco
authors.initials: F
authors.lastname: Cognetti
authors.forename: Alessandra
authors.initials: A
authors.lastname: Fabi
authors.forename: Sabino
authors.initials: S
authors.lastname: De Placido
authors.forename: Grazia
authors.initials: G
authors.lastname: Arpino
authors.forename: Paolo
authors.initials: P
authors.lastname: Marchetti
authors.forename: Andrea
authors.initials: A
authors.lastname: Botticelli
authors.forename: Paolo
authors.initials: P
authors.lastname: Pronzato
authors.forename: Elisa
authors.initials: E
authors.lastname: Martelli
keywords: Italy; conventional paclitaxel; cost-effectiveness analysis; metastatic breast cancer; nab-paclitaxel