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Taxane-Based Breast Cancer Treatment Cost-Effective Compared With 5-Fluorouracil-Based Therapy: Presented at SABCS
By Ed Susman
SAN ANTONIO, TX -- December 13, 2005 -- Despite higher drug costs and more adverse effects, researchers say a combination of docetaxel, doxorubicin, and cyclophosphamide (TAC) is not only clinically effective but also cost effective.
The researchers analyzed the results of the Breast Cancer International Research Group (BCIRG) 001 study, in which the switch to docetaxel (Taxotere) instead of 5-fluorouracil (FAC) resulted in prolonged disease-free and overall survival for women with node-positive breast cancer when the treatment was offered in the adjuvant setting.
Both groups in the BCIRG trial also received cyclophosphamide and doxorubicin (Adriamycin).
"The incremental cost-effectiveness ratio for TAC, compared to FAC adjuvant chemotherapy was $18,506 (CND) per quality year of life gained, from a Canadian healthcare system perspective," said Heather-Jane Au, MD, PhD, assistant professor of medicine, University of Alberta and Cross Cancer Institute, Edmonton, Alberta, Canada.
Dr. Au discussed her study findings here during a poster presentation on December 10th at the 28th Annual San Antonio Breast Cancer Symposium (SABCS).
Most economists consider that a cost that is less than $50,000 per quality year of life gained is a cost-effective, Dr. Au said.
"Though the upfront costs and acute toxicities of TAC were higher than those of FAC, these were in part offset by the cost and quality-of-life impact of the higher rates of disease recurrence and palliative care needs seen with FAC adjuvant therapy," she said.
She said that in figuring cost-effectiveness, the researchers also threw into the model factors that were not part of the clinical trial. "Most clinicians, in order to prevent bouts of febrile neutropenia would add GM-CSF [granulocyte monocyte colony stimulating factor]," she said.
The potentially life-saving drug adds considerable expense to the treatment, she noted, but at $46,003.09 per quality year of life gained, it would still fall under the Western umbrella of being cost-effective.
Dr. Au also performed another alternative cost-effectiveness adjustment considering that recent studies would treat only patients who are HER2-negative in the trial, since HER2-positive patients would likely be treated with trastuzumab (Herceptin). Using that analysis, Dr. Au found it would cost $34,951.13 for quality year of life gained by using the TAC regimen.
"We included this analysis to be a real-time study," she said.
[Presentation title: Cost-Effectiveness of Adjuvant Chemotherapy for Node Positive Breast Cancer: Modeling the Downstream Effects of Adjuvant TAC vs FAC: Docetaxel, Adriamycin, Cyclophosphamide Compared to 5-Fluorouracil AC. Abstract 5038]
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