Background: The taxanes (paclitaxel {Taxol} docetaxel {Taxotere} and nab paclitaxel {Abraxane}) are used in women with Results Figure 1 Hazard ratio for neutropenia Figure 2 Hazard ratio for infections
Background: It has been estimated that over $8 billion is spent annually on the management of breast cancer in the US. The taxane chemotherapeutic agents are cornerstones in the treatment of breast cancer.Although the solvent-based taxanes, generic paclitaxel (Taxol and others) and docetaxel (Taxotere), have lower drug acquisition costs than nab-paclitaxel (Abraxane), nab-paclitaxel offers potential clinical advantages such as better tumor responses with lower rates of severe neutropenia and infusion-related reactions. In order to evaluate whether taxane choice affects the economic outcomes of metastatic breast cancer (MBC) treatment, we evaluated the total cost of care of a cohort of women with MBC.Objective: To determine if differences exist in the total cost of care in patients receiving taxane-based chemotherapy for MBC. Additionally, a comparison between the taxanes was performed on the use of ancillary medications (for neutropenia, anemia, and nausea and vomiting) and their associated costs. Costs per utilizing patient with MBC per month were calculated and compared.Methods: Women with MBC were identified with ICD-9-CM codes and by their prior use of adjuvant chemotherapeutic regimens. Paid medical claims from the period of January 1, 2006 to December 31, 2007 were captured.The study groups were determined according to the taxane administered to women with MBC. Total medical costs were captured from the date of first taxane administration forward to the end of data availability. Outpatient pharmacy costs were not available. Median total medical costs per patient with MBC per month (PPPM) were adjusted for a variety of variables. Utilization and costs of ancillary medications were captured and adjusted with Tobit models.Results: Over the 24-month period, 2,245 women with MBC were identified. There were 1,035 women in the docetaxel group, 997 received paclitaxel, and 213 received nab-paclitaxel. On average, patients in the nab-paclitaxel groups received more doses (9.6) than either generic paclitaxel (6.0) or docetaxel (4.8). The multivariate analysis was robust, explaining 72% of the variability in total medical costs across the 3 taxane groups. Median PPPM total medical costs for women with MBC were within approximately $800 of each other; docetaxel ($4,042; 95% CI, $3,844 - $4,251) and nab-paclitaxel ($3,997; 95% CI, $3,634 - 4,396) total costs were not different whereas generic paclitaxel was less costly ($3,203; 95% CI, $3,029 - $3,388). Nab-paclitaxel had the lowest utilization and lowest costs associated with colony-stimulating factors (CSF).Erythropoietin stimulating agent (ESA) utilization was not significantly different between the 3 drugs. However, compared with docetaxel, ESA expenditures in patients receiving nab-paclitaxel were significantly lower. Anti-emetic use was highest in the docetaxel group, but costs were not different between the three taxanes.Conclusions: For patients with MBC, differences in total medical costs between the three taxanes were modest. Total medical costs were lowest for patients receiving generic paclitaxel and comparable between docetaxel and nab-paclitaxel. Patients on nab-paclitaxel received more doses than the other taxanes. Nab-paclitaxel was associated with lower utilization and costs for CSF compared with generic paclitaxel and docetaxel. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1076.
Background: The taxanes (paclitaxel, docetaxel, and albumin-bound paclitaxel) are used in women with metastatic breast cancer (MBC). Clinical trials indicate that these drugs may differ in their toxicity profiles, including rates of neutropenia and need for colony stimulating factor (CSF) supportive therapy. Utilizing medical claims data, we evaluated prophylactic and treatment-related CSF use among women receive taxane-based chemotherapy regimens. Objective: To determine if differences exist in rates of CSF use for prophylaxis, treatment and associated costs in women receiving taxane-based chemotherapy for MBC. Methods: Women with MBC were identified with ICD-9-CM codes and by their prior use of adjuvant chemo regimens. Paid medical claims (source: Ingenix Consulting) from May 1, 2006 to April 30, 2009 were analyzed. Study groups were defined according to the first taxane administered. CSF utilization was classified as prophylaxis (0-5 days post-taxane administration), treatment (6-21 days post-taxane,) or non-taxane associated use (>21 days post-taxane). Comparisons were made between the taxane groups. All CSF costs were captured from date of first taxane to end of taxane therapy +21 days and categorized as above. Patients censored if ≥35 days elapsed with no taxane therapy. Two-stage regression analyses were performed. Control variables included age, Romano comorbidity score, and use of prior and other concurrent chemotherapy. Results: 4,503 women (mean age: 53 +/− 10 years) with MBC were identified: 2,599 in the docetaxel group; 1,643 received paclitaxel; and 261 received nab-paclitaxel. More patients receiving docetaxel received any CSF (75.6%) than either paclitaxel (49.8%) or albumin-bound paclitaxel (36.8% P<0.05 for each comparison). For docetaxel 70.5% of women received prophylactic CSF, whereas the rates were 47.0% for paclitaxel and 33.0 for albumin-bound paclitaxel (P<0.05). The rate of women receiving CSF in the albumin-bound paclitaxel group was not different than the other groups. Daily per-patient CSF expenditures during taxane therapy were $176.81 (95% CI, $168.20-$185.52) for docetaxel, $127.71(95% CI, $113.62-$142.60) for paclitaxel, and 46.24 (95% CI, $29.37-$67.25) for albumin-bound paclitaxel. Conclusions: Compared with docetaxel and paclitaxel, patients receiving albumin-bound paclitaxel had significantly lower prophylactic CSF use, yet did not experience any difference in treatment-related use. Daily per-patient CSF expenditures for albumin-bound paclitaxel were significantly lower than the other two taxanes. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-10-03.
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