Cost-effectiveness of adjuvant docetaxel for node-positive breast cancer patients: results of the PACS 01 economic study

• Published in: Annals of oncology Vol. 21; no. 7; pp. 1448 - 1454
• Main Authors: Marino, P., Siani, C., Roché, H., Protière, C., Fumoleau, P., Spielmann, M., Martin, A.-L., Viens, P., Le Corroller Soriano, A.-G.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.07.2010; Oxford University Press; Elsevier
• Subjects: Adult; Aged; Anthracyclines - administration & dosage; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - economics; Breast Neoplasms - pathology; Cancer; Chemotherapy, Adjuvant; Cost-Benefit Analysis; cost-effectiveness; Docetaxel; Female; Gynecology. Andrology. Obstetrics; Humans; Life Sciences; Lymph Nodes - pathology; Mammary gland diseases; Medical sciences; Middle Aged; Models, Economic; Neoplasm Metastasis; Neoplasm Staging; Pharmacology. Drug treatments; Quality-Adjusted Life Years; Santé publique et épidémiologie; Survival Rate; taxanes; Taxoids - administration & dosage; Treatment Outcome; Tumors; uncertainty; cost-effectiveness; breast cancer; uncertainty; taxanes; Antineoplastic agent; Human; Breast disease; Docetaxel; Node; Patient; Breast cancer; Malignant tumor; Mammary gland diseases; Taxane derivatives; Health economy; Economic aspect; Antimitotic; Cancer; Cost efficiency analysis
• ISSN: 0923-7534; 1569-8041
• DOI: 10.1093/annonc/mdp561

Using data from the PACS 01 randomized trial, we evaluated the cost-effectiveness of anthracyclines plus docetaxel (Taxotere; FEC-D) versus anthracyclines alone (FEC100) in patients with node-positive breast cancer. Costs and outcomes were assessed in 1996 patients and the incremental cost-effectiveness ratios (ICERs) were estimated, using quality-adjusted life years (QALYs) as outcome. To deal with uncertainty due to sampling fluctuations, confidence regions around the ICERs were calculated and cost-effectiveness acceptability curves were drawn up. Sensitivity analyses were also carried out to assess the robustness of conclusions. The mean cost of treatment was 33% higher with strategy FEC-D, but this difference decreased to 18% at a 5-year horizon. The ICER of FEC-D versus FEC100 was estimated to be 9665€ per QALY gained (95% confidence interval €2372–€55515). The estimated probability that FEC-D was cost-effective reached >96% for a threshold of €50000 per QALY gained. If the price of taxane decreased slightly, the ICER would reach some very reasonable levels and this strategy would therefore be much more cost-effective. The sequential use of FEC100 followed by docetaxel appears to be a cost-effective alternative, even when uncertainty is taken into account.