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Docetaxel in Combination With Doxorubicin and Cyclophosphamide As Adjuvant Treatment for Early Node-Positive Breast Cancer: A Cost-Effectiveness and Cost-Utility Analysis

Sorrel E. Wolowacz, David A. Cameron, Helen C. Tate, Adrian Bagust

From RTI-Health Solutions, Manchester; Department of Oncology, Western General Hospital, Edinburgh; New House Farm, Purton End, Debden, Saffron Walden Essex, UK; and Prescribing Research Group, The University of Liverpool Management School, Liverpool, United Kingdom

Corresponding author: Sorrel E. Wolowacz, PhD, RTI-Health Solutions, Williams House, University of Manchester Science Park, Manchester M15 6SE, United Kingdom; e-mail: swolowacz{at}rti.org

Purpose: To estimate the cost effectiveness of TAC (docetaxel, doxorubicin, and cyclophosphamide) compared with FAC (fluorouracil, doxorubicin, and cyclophosphamide) when administered as adjuvant therapy to women with node-positive early breast cancer in the United Kingdom (UK), both with and without primary prophylaxis with granulocyte colony-stimulating factor (G-CSF).

Methods: A standard health economic Markov model estimated the cost and outcome for node-positive early breast cancer patients, from initiation of adjuvant chemotherapy to death. Patient-level data were used from the Breast Cancer International Research Group (BCIRG) 001 trial for estimates of the effect of chemotherapy on toxicity and outcome, and an observational data set collected from a UK university hospital provided estimates of resource use and outcome for patients with relapsed disease.

Results: Over a 10-year analysis timeframe, the incremental cost per life-year saved associated with the use of TAC rather than FAC was estimated as £15,418 (95% CI, £13,734 to £17,997) and the incremental cost per quality-adjusted life-year gained (IC/QALY) was £18,188 (95% CI, £14,161 to £32,422). The addition of primary G-CSF (lenograstim or filgrastim) to the TAC regimen resulted in an IC/QALY of £20,432. The results were most sensitive to the quality-of-life (QOL) score for patients in remission postchemotherapy. However, even if QOL was assumed to be as poor as for patients with metastatic disease, the IC/QALY estimate rose only to £32,430.

Conclusion: The use of adjuvant TAC rather than FAC for node-positive early breast cancer patients is cost effective, despite the increased drug and toxicity treatment costs, and when primary G-CSF prophylaxis is given to all patients.

Supported by a grant from Sanofi-aventis to Western General Hospital, Edinburgh, United Kingdom, to cover costs of data retrieval. RTI-HS was commissioned by Sanofi-aventis Inc to perform the modeling work. Contractual arrangements between RTI-HS and Sanofi-aventis did not prevent RTI-HS from independently publishing this work. This manuscript was reviewed by Sanofi-aventis.

The model reported herein was used to support submissions to the UK National Institute for Health and Clinical Excellence (NICE) and the Scottish Medicines Consortium (SMC).

Presented in part at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 8th Annual European Congress, November 6-8, 2005, Florence, Italy.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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