The Cost Effectiveness of Docetaxel and Active Symptom Control versus Active Symptom Control Alone for Refractory Oesophagogastric Adenocarcinoma: Economic Analysis of the COUGAR-02 Trial.
BACKGROUND
The COUGAR-02 trial recently showed survival and quality-of-life benefits of docetaxel and active symptom control (DXL + ASC) over active symptom control (ASC) alone in patients with refractory oesophagogastric adenocarcinoma.


OBJECTIVE
The aim of this study was to conduct an economic evaluation conforming to National Institute for Health and Care Excellence (NICE) technology appraisal guidance to evaluate the cost effectiveness of DXL + ASC versus ASC from the perspective of the English National Health Service (NHS).


METHODS
Cost-utility analyses were conducted using trial data. Utility values were captured using the EQ-5D completed by patients at 3- and 6-weekly intervals, while resource use was captured using nurse-completed report forms and patient reports. Incremental cost-effectiveness ratios (ICERs) were calculated and the main outcome was cost per incremental quality-adjusted life-year (QALY). Nonparametric bootstrapping was conducted to capture sampling uncertainty and to generate a cost-effectiveness acceptability curve (CEAC). The analysis horizon was the trial period (median follow-up 12 months) and no modelling or discounting of future costs and benefits was conducted.


RESULTS
Average costs were £9352 and £6218 for DXL + ASC and ASC, respectively, and average QALYs were 0.302 and 0.186, respectively. This yielded an ICER of £27,180 for DXL + ASC. DXL + ASC had a 24 % chance of being cost effective at a £20,000 QALY threshold (lambda) and a mean net monetary benefit of -£821; this rose to 59 % and £332 when the threshold was raised to £30,000. If NICE end-of-life criteria are applied, the probability of cost effectiveness increases to 90 % (at lambda = £50,000). Results were robust to sensitivity analyses.


CONCLUSIONS
DXL + ASC is likely to be cost effective if an end-of-life premium is applied. Further research should determine the impact of different utility measurement strategies and different chemotherapy delivery modes on estimates of cost effectiveness.
Academic Unit of Health Economics, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, 101 Clarendon Road, Leeds, LS2 9LJ, UK. D.Meads@leeds.ac.uk.
David M
DM
Meads
Warwick Clinical Trials Unit, University of Warwick, Conventry, UK.
Andrea
A
Marshall
Academic Unit of Health Economics, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, 101 Clarendon Road, Leeds, LS2 9LJ, UK.
Claire T
CT
Hulme
Warwick Clinical Trials Unit, University of Warwick, Conventry, UK.
Janet A
JA
Dunn
Addenbrooke's Hospital, Cambridge, UK.
Hugo E R
HE
Ford
D000230:Adenocarcinoma / Q000188:drug therapy* / Q000191:economics*; D003362:Cost-Benefit Analysis; D000077143:Docetaxel; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000191:economics; D005770:Gastrointestinal Neoplasms / Q000188:drug therapy* / Q000191:economics*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D019057:Quality-Adjusted Life Years; D043823:Taxoids / Q000627:therapeutic use*
D043823:Taxoids; D000077143:Docetaxel