The Cost–Utility of Adjuvant Chemotherapy Using Docetaxel and Cyclophosphamide Compared with Doxorubicin and Cyclophosphamide in Breast Cancer

Younis, Tallal; Rayson, Daniel; Skedgel, Chris

doi:10.3747/co.v18i6.810

Cited by 26 publications

(23 citation statements)

References 40 publications

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“…They showed that the high cost of the PG regimen was due to the costs of chemotherapy drugs in PG regimen and the Gemcitabin on the eighth day (Chen et al, 2002). Bernard et al in 2011, Younis et al in 2011 and Liubao in separate studies showed that the low cost of the AC regimen was due to the costs of chemotherapy drugs in AC regimen (Liubao et al, 2009;Bernard et al, 2011;Younis et al, 2011).…”

Section: Discussionmentioning

confidence: 99%

“…Standard chemotherapy regimens for advanced breast cancer patients is drug regimen containing doxorubicin group which, according to several studies, leads to a reduction in tumor recurrence and increased prognosis of patients . Newly taxane drugs as neoadjuvant regimens is used hoping to get a better response and in neoadjuvant conditions they have shown a good activity and acceptable toxicity and lead to increased pathological complete response (Younis et al, 2011;Mohammadianpanah et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

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Cost-Utility of "Doxorubicin and Cyclophosphamide" versus "Gemcitabine and Paclitaxel" for Treatment of Patients with Breast Cancer in Iran

Hatam

Askarian²,

Javan-Noghabi³

et al. 2016

Asian Pacific Journal of Cancer Prevention

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Purpose: A cost-utility analysis was performed to assess the cost-utility of neoadjuvant chemotherapy regimens containing doxorubicin and cyclophosphamide (AC) versus paclitaxel and gemcitabine (PG) for locally advanced breast cancer patients in Iran. Materials and Methods: This cross-sectional study in Namazi hospital in Shiraz, in the south of Iran covered 64 breast cancer patients. According to the random numbers, the patients were divided into two groups, 32 receiving AC and 32 PG. Costs were identified and measured from a community perspective. These items included medical and non-medical direct and indirect costs. In this study, a data collection form was used. To assess the utility of the two regimens, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core30 (EORTC QLQ-C30) was applied. Using a decision tree, we calculated the expected costs and quality adjusted life years (QALYs) for both methods; also, the incremental cost-effectiveness ratio was assessed. Results: The results of the decision tree showed that in the AC arm, the expected cost was 39,170 US$ and the expected QALY was 3.39 and in the PG arm, the expected cost was 43,336 dollars and the expected QALY was 2.64. Sensitivity analysis showed the cost effectiveness of the AC and ICER=-5535 US$. Conclusions: Overall, the results showed that AC to be superior to PG in treatment of patients with breast cancer, being less costly and more effective.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cost-Utility of "Doxorubicin and Cyclophosphamide" versus "Gemcitabine and Paclitaxel" for Treatment of Patients with Breast Cancer in Iran

Hatam

Askarian²,

Javan-Noghabi³

et al. 2016

Asian Pacific Journal of Cancer Prevention

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“…The upfront costs of chemo were derived from local unit costs at the Queen Elizabeth II Health Sciences Centre, in Halifax, Nova Scotia, Canada [30], while the downstream costs of follow up, treatment of recurrent disease and adverse events were derived from the literature (Table 2) [30,31,40,45,47,48]. The analysis took a third-party direct payer perspective.…”

Section: Costs and Utilitiesmentioning

confidence: 99%

Cost-utility of the 21-gene recurrence score assay in node-negative and node-positive breast cancer

Lamond

Skedgel

Rayson

et al. 2012

Breast Cancer Res Treat

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The 21-gene recurrence score (Oncotype DX: RS) appears to augment clinico-pathologic prognostication and is predictive of adjuvant chemotherapy benefit in node-negative (N-) and node-positive (N+), endocrine-sensitive breast cancer. RS is a costly assay that is associated with good 'value for money' in N- disease, while economic evaluations in N+ disease based on most recent data have not been conducted. We examined the cost-utility (CU) of a RS-guided adjuvant strategy, compared to current practice without RS in N- and N+, endocrine-sensitive, breast cancer from a Canadian health care system perspective. A generic state-transition model was developed to compute cumulative costs and quality-adjusted life years (QALYs) over a 25-year horizon. Patient outcomes with and without chemotherapy in RS-untested cohorts and in those with low, intermediate and high RS were examined based on the reported prognostic and predictive impact of RS in N- and N+ disease. Chemotherapy utilization (current vs. RS-guided), unit costs and utilities were derived from a Nova Scotia Canadian population-based cohort, local unit costs and the literature. Costs and outcomes were discounted at 3% annually, and costs were reported in 2011 Canadian dollars ($). Probabilistic and one-way sensitivity analyses were conducted for key model parameters. Compared to a non-RS-guided strategy, RS-guided adjuvant therapy was associated with $2,585 and $864 incremental costs, 0.27 and 0.06 QALY gains, and resultant CUs of $9,591 and $14,844 per QALY gained for N- and N+ disease, respectively. CU estimates were robust to key model parameters, and were most sensitive to chemo utilization proportions. RS-guided adjuvant therapy appears to be a cost-effective strategy in both N- and N+, endocrine-sensitive breast cancer with resultant CU ratios well below commonly quoted thresholds.

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“…The long-term phase of the model was based on a previously published model [13,14] and began with all patients in a disease-free state following adjuvant therapy. Patients could experience a local or distant recurrence or die as a result of statespecific or background mortality.…”

Section: Methodsmentioning

confidence: 99%

“…The costs of treating cancer recurrences were derived from a Canadian model of cancer costs [19]. As in our previous work, other health state costs, including adverse events, were derived from the literature [14,20]. All costs were converted into monthly or one-time event-driven costs and adjusted to 2014 Canadian dollars using the Statistics Canada Consumer Price Index health component [21].…”

Section: Costs and Utilitiesmentioning

confidence: 99%

Is febrile neutropenia prophylaxis with granulocyte-colony stimulating factors economically justified for adjuvant TC chemotherapy in breast cancer?

Skedgel

Rayson

Younis

2015

Support Care Cancer

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The Cost–Utility of Adjuvant Chemotherapy Using Docetaxel and Cyclophosphamide Compared with Doxorubicin and Cyclophosphamide in Breast Cancer

Abstract: ConclusionsRelative to ac, tc is a cost-effective adjuvant chemotherapy regimen, with a cost-effectiveness ratio well below commonly applied thresholds.

Cited by 26 publications

References 40 publications

Cost-Utility of "Doxorubicin and Cyclophosphamide" versus "Gemcitabine and Paclitaxel" for Treatment of Patients with Breast Cancer in Iran

Cost-Utility of "Doxorubicin and Cyclophosphamide" versus "Gemcitabine and Paclitaxel" for Treatment of Patients with Breast Cancer in Iran

Cost-utility of the 21-gene recurrence score assay in node-negative and node-positive breast cancer

Is febrile neutropenia prophylaxis with granulocyte-colony stimulating factors economically justified for adjuvant TC chemotherapy in breast cancer?

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