Cost-effectiveness of new guidelines for adjuvant systemic therapy for patients with primary breast cancer

Kievit, Wietske; Bolster, Marieke J.; Wilt, Gert Jan van der; Bult, Peter; Thunnissen, Erik; Meijer, Jos W. R.; Strobbe, L.J.A.; Klinkenbijl, Jean H. G.; Wobbes, Theo; Adang, Eddy; Beex, L.V.A.M.; Tjan-Heijnen, V. C. G.

doi:10.1093/annonc/mdi394

Cited by 9 publications

(2 citation statements)

References 23 publications

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“…It is conceivable, however, that adjuvant systemic therapy and relapsed disease also incurs substantial nonmedical and personal costs for patients, e.g. travel costs to the hospital and home nursing costs [22]. Third, the number of hospitals surveyed for cost data was three; this limited number of participating hospitals raises the question as to whether they represent the Korean standard.…”

Section: Sensitivity Analysismentioning

confidence: 99%

Cost–effectiveness analysis of adjuvant therapy for node positive breast cancer in Korea: docetaxel, doxorubicin and cyclophosphamide (TAC) versus fluorouracil, doxorubicin and cyclophosphamide (FAC)

Kim

Jee

Chung

et al. 2008

Breast Cancer Res Treat

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Section: Sensitivity Analysismentioning

confidence: 99%

Cost–effectiveness analysis of adjuvant therapy for node positive breast cancer in Korea: docetaxel, doxorubicin and cyclophosphamide (TAC) versus fluorouracil, doxorubicin and cyclophosphamide (FAC)

Kim

Jee

Chung

et al. 2008

Breast Cancer Res Treat

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“…Based on all these cost analyses it is very important to have effective outpatient adjuvant breast cancer treatments. In addition in a recent study by Kievit et al [38] the new guidelines of the adjuvant treatment of breast cancer have affected the number of patients eligible to adjuvant studies and the cost-effectiveness ratio of about 4837 t per life year gained is well within the range of values that are generally considered acceptable. In our study HDCT with PSCT (group B) was significantly more costly than doseescalated FEC with growth factor support (group A), when direct health care costs are considered, even though over half of the costs in group A comprised of costs of growth factors.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of intensive adjuvant chemotherapy for high-risk breast cancer: Is tailored and dose-escalated chemotherapy with growth factor support (GFS) more costly and less effective than marrow-supported high-dose chemotherapy – results from a randomized study

et al. 2007

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Based on randomized studies bone-marrow supported (BMS) high-dose chemotherapy (HDCT) is not superior to conventional CT as adjuvant treatment for high-risk breast cancer. To compare the cost-effectiveness of these treatments we examined the data of Finnish patients in the SBG9401 trial 1. Patients were randomized to receive either dose-escalated (de FEC) (group A, n =59) or FEC and HDCT+BMS (group B, n =70). They received adjuvant radiotherapy (RT) + tamoxifen. All direct health care costs of first line treatment at the oncology units were considered as well as productivity costs within the first 3 years of follow-up. Effectiveness was measured by the number of survival days during 5 years of follow-up. The mean direct health care costs were significantly higher in group B (25829 euro in group A vs. 36605 euro in group B, p <0.001), mainly due to a higher number of hospital days. Half of the costs in group A was due to the use of filgrastim (15335 euro in A and 2969 euro in B, p <0.001). The costs of RT were only 5% of total costs. There was no statistically significant difference between the groups in the number of survival days, but sensitivity analysis based on bootstrapping suggested that treatment A would be a less costly and more effective alternative in a great majority of cases.

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Factors contributing to improved local control after mastectomy in patients with breast cancer aged 40 years or younger

et al. 2010

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Long-term local control rates were studied in a series of 659 patients with invasive breast cancer aged 40 years or younger, who underwent mastectomy in general hospitals in the southern part of the Netherlands between 1988 and 2005. During a median follow-up time of 6.0 years, 34 patients developed a local recurrence in the chest wall without previous or simultaneous evidence of distant disease. The 5- and 10-year actuarial local recurrence rates for the total group were 5.6% (95% confidence interval [95% CI], 3.5-7.7%) and 7.3% (95% CI, 4.7-9.9%), respectively. A multivariate analysis showed that patients receiving radiotherapy (hazards ratio [HR], 0.29; 95% CI, 0.10-0.96) or adjuvant systemic treatment (HR 0.23; 95% CI, 0.08-0.65) had a significantly lower risk of local recurrence. It is concluded that excellent local control rates can be obtained with mastectomy in young women with breast cancer, especially in those who receive adjuvant systemic treatment and/or radiotherapy.

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Cost-effectiveness of new guidelines for adjuvant systemic therapy for patients with primary breast cancer

Abstract: Introduction of the new guideline considerably affected the number of patients eligible for adjuvant systemic therapy for breast cancer. The associated incremental cost-effectiveness ratio is well within the range of values that are generally considered acceptable.

Cited by 9 publications

References 23 publications

Cost–effectiveness analysis of adjuvant therapy for node positive breast cancer in Korea: docetaxel, doxorubicin and cyclophosphamide (TAC) versus fluorouracil, doxorubicin and cyclophosphamide (FAC)

Cost–effectiveness analysis of adjuvant therapy for node positive breast cancer in Korea: docetaxel, doxorubicin and cyclophosphamide (TAC) versus fluorouracil, doxorubicin and cyclophosphamide (FAC)

Cost-effectiveness of intensive adjuvant chemotherapy for high-risk breast cancer: Is tailored and dose-escalated chemotherapy with growth factor support (GFS) more costly and less effective than marrow-supported high-dose chemotherapy – results from a randomized study

Factors contributing to improved local control after mastectomy in patients with breast cancer aged 40 years or younger

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