Can sequential administration minimise the cost of high dose chemotherapy? An economic assessment in inflammatory breast cancer

• Published in: PharmacoEconomics Vol. 21; no. 11; pp. 807 - 818
• Main Authors: MARINO, Patricia, LE CORROLLER, Anne-Gaelle, PALANIE, Thao, JANVIER, Maud, FABBRO, Michel, MOLINIER, Laurent, DELOZIER, Thierry, LIVARTOWSKI, Alain, MOATTI, Jean-Paul, VIENS, Patrice
• Format: Journal Article
• Language: English
• Published: Auckland Adis International 01.01.2003; Springer Healthcare | Adis; Springer
• Series: PharmacoEconomics
• Subjects: Adolescent; Adult; Aged; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - economics; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Antineoplastics; Biological and medical sciences; Bone Marrow Transplantation - economics; Bone-marrow-transplant; Breast Neoplasms - drug therapy; Breast Neoplasms - surgery; Breast-cancer; Chemotherapy; Cisplatin; Combined Modality Therapy; Cost Savings; Cost-analysis; Cyclophosphamide; Direct Service Costs - statistics & numerical data; Doxorubicin; Drug Administration Schedule; Drug Costs - statistics & numerical data; Etoposide; Female; Filgrastim; Fluorouracil; France; Granulocyte Colony-Stimulating Factor - administration & dosage; Granulocyte Colony-Stimulating Factor - economics; Granulocyte-colony-stimulating-factors; Health technology assessment; Hospitals, Public - economics; Humans; Medical sciences; Melphalan; Middle Aged; Mitoxantrone; Peripheral Blood Stem Cell Transplantation - economics; Pharmacoeconomics; Pharmacology. Drug treatments; Recombinant Proteins; Stem-cell-transplant; France; Europe; Antineoplastic agent; Human; Stem cell; Administration schedule; Malignant tumor; Filgrastim; Mammary gland diseases; Chemotherapy; Treatment; Hematopoiesis; Sequential method; Health economy; Mammary gland; Cost analysis; High dose; Treatment planning
• ISSN: 1170-7690; 1179-2027
• DOI: 10.2165/00019053-200321110-00004

To evaluate the potential cost savings of using sequential high dose chemotherapy (HDC), with granulocyte colony-stimulating factor (filgrastim) and stem cell support, rather than single course administration of HDC with bone marrow transplantation (BMT) or peripheral blood stem cell transplantation (PBSCT). French public hospital perspective. Direct medical costs of sequential treatment, estimated on the basis of physical quantities of resources consumed by 95 patients with inflammatory breast cancer (IBC) included in a French pilot multicentric trial (PEGASE 02), were compared with those of historical control groups of patients treated with single course HDC, either with BMT (n = 27) or PBSCT (n = 14). Costs were evaluated in 1998 French francs (1 Euro = 6.55957 French francs). The total cost of sequential HDC was significantly lower than that for single course HDC both with BMT (-29%; 22,755 Euros vs 32,284 Euros; p < 0.001) or PBSCT (-16%; 22,755 Euros vs 27,209 Euros; p = 0.026). This was mainly due to a reduction in the length of hospitalisation in transplantation units. According to our results, economic arguments cannot be used against the widespread use of sequential HDC for patients with IBC. However, further economic evaluations based on overall and disease-free survivals alongside a randomised clinical trial are still needed to definitively establish the cost effectiveness of sequential administration of HDC.