Docetaxel in Combination with Doxorubicin and Cyclophosphamide as Adjuvant Treatment for Early Node-Positive Breast Cancer in the USA: A Cost-Effectiveness and Cost-Utility Analysis.
Authors: S. Wolowacz, B. Seal, M. Tangirala
Journal: Cancer Research (2009)

Abstract OBJECTIVE9/15/2009 To estimate the cost effectiveness of TAC (docetaxel 75mg/m2, doxorubicin 50mg/m2, and cyclophosphamide 500mg/m2 6 cycles) compared with FAC (fluorouracil 500mg/m2, doxorubicin 50mg/m2, and cyclophosphamide 500mg/m2 6 cycles) when administered as adjuvant therapy to women with node-positive early breast cancer in the USA, both with and without primary prophylaxis with granulocyte colony-stimulating factor (G-CSF).METHODS: A Markov model estimated costs and outcomes from initiation of adjuvant chemotherapy to death. Patient-level data from the Breast Cancer International Research Group (BCIRG) 001 trial provided estimates of the effect of chemotherapy on toxicity and outcome. Costs were estimated from US databases (Pharmetrics and Premier) and a published analysis of linked SEER-Medicare data for 1580 patients with disease recurrence (cost year 2008). Utility weights were estimated from Organization for Research and Treatment of Cancer Core Questionnaire (EORTC QLQ-C30) data collected in trial BCIRG 001 and from the published literature. Probabilistic sensitivity analysis was performed in which the mean value of each model parameter was sampled randomly from its statistical distribution. 1,000 simulations were performed to generate a distribution of total expected costs, life years and quality-adjusted life years (QALYs), which reflected the aggregated uncertainty of the model parameters.RESULTS: The results are presented in Table 1 and Figure 1.Table 1. Total expected lifetime costs and outcomes for patients receiving TAC and FAC TACFACIncremental difference (TAC - FAC)Mean Cost per patient (95% Confidence Intervals)$33,379 ($27,530 - $48,320)$13,647 ($10,764 - $17,707)$19,732 ($15,869 - $31,441)Mean life years per patient (95% Confidence Intervals)12.43 (12.04 - 12.94)11.51 (11.08 - 12.05)0.93 (0.87 - 0.97)Mean QALYs per patient (95% Confidence Intervals)9.53 (6.18 - 11.54)8.79 (5.72 - 10.64)0.74 (0.44 - 0.91) Over patients' lifetimes, the incremental cost per life-year saved associated with use of TAC rather than FAC was estimated as $21,318 (95% confidence intervals, $16,953 to $33,856) and the incremental cost per QALY was $26,654 ($18,553 to $50,554). The addition of primary G-CSF (filgrastim) to the TAC regimen resulted in an incremental cost per life-year saved of $21,775. The results were most sensitive to the quality-of-life score for patients in remission postchemotherapy. However, even if quality of life was assumed to be as poor as for patients with metastatic disease, the incremental cost per QALY estimate rose only to $44,122.CONCLUSION: Use of adjuvant TAC rather than FAC for node-positive early breast cancer patients is cost effective in the US setting, despite the increased drug cost and the cost and quality of life implications of toxicity. TAC supported by primary G-CSF prophylaxis is also cost-effective compared with FAC. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2091.