+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

A new decision model for cost-utility comparisons of chemotherapy in recurrent metastatic breast cancer

A new decision model for cost-utility comparisons of chemotherapy in recurrent metastatic breast cancer

Pharmacoeconomics 9(Suppl. 2): 8-22

In the absence of comparative clinical and pharmacoeconomic trial data for docetaxel versus paclitaxel as second-line therapy for patients with anthracycline-resistant metastatic breast cancer, a computer-based decision-analysis model was designed to evaluate the comparative utility to patients of these two taxoids. The model used the Markov process to analyse disease states (response, stable disease, progressive disease) and toxicities (acute, cumulative) for each treatment during the period from commencement of up to six 3-weekly cycles of chemotherapy, to death. A cost-utility analysis was carried out using the model, with a probability, a cost and a utility determined for each health state. Response rates were obtained from clinical trial data supplemented by expert clinical opinion. Costs were taken from UK national databases and published sources and the published UK prices of docetaxel and paclitaxel. Utilities for the various health states were established by use of standard gamble and visual analogue methods assessed by 30 oncology nurses in the UK who were acting as proxy patients. The results of the model showed that response rate is the key parameter determining the utility and cost utility of treatments for metastatic breast cancer. Although the total per-patient cost associated with docetaxel was marginally higher than that for paclitaxel (8233 pounds vs 8013 pounds), the higher response rate associated with docetaxel produced an improvement in utility to the patient at an incremental healthcare cost that is acceptable according to available defined limits. Sensitivity analyses revealed that, although the model was sensitive to changes in response rate and drug costs, the cost-utility ratio for docetaxel versus paclitaxel varied within acceptable limits in response to all likely changes in key parameters. In summary, in the base case used in this model, docetaxel produces a substantially larger utility benefit than paclitaxel, at a small additional cost per QALY gained (equivalent to 7 pounds per additional day of perfect health).

Please choose payment method:

(PDF emailed within 1 workday: $29.90)

Accession: 045079813

Download citation: RISBibTeXText

PMID: 10163967

Related references

A New Decision Model for Cost-Utility Comparisons of Chemotherapy in Recurrent Metastatic Breast Cancer. Pharmacoeconomics 9(2 Suppl.): 8-22, 1996

A Cost-Utility Analysis of Second-Line Chemotherapy in Metastatic Breast Cancer. PharmacoEconomics 10(5): 504-521, 1996

A cost--utility analysis comparing second-line chemotherapy schemes in patients with metastatic breast cancer. Anti-Cancer Drugs 12(6): 533-540, 2001

A cost-utility analysis of second-line chemotherapy in metastatic breast cancer. Docetaxel versus paclitaxel versus vinorelbine. Pharmacoeconomics 10(5): 504-521, 1996

Efficacy and cost effectiveness of adjuvant chemotherapy in women with node-negative breast cancer. A decision-analysis model. New England Journal of Medicine 324(3): 160-168, 1991

Development and verification of a prediction model using serum tumor markers to predict the response to chemotherapy of patients with metastatic or recurrent breast cancer. Journal of Cancer Research and Clinical Oncology 134(11): 1199-1206, 2008

Cost utility in second-line metastatic breast cancer. Pharmacoeconomics 11(5): 492-497, 1997

A cost-utility analysis of risk model-guided versus physician's choice antiemetic prophylaxis in patients receiving chemotherapy for early-stage breast cancer: a net benefit regression approach. Supportive Care in Cancer 25(8): 2505-2513, 2017

End of chemotherapy decision for metastatic breast cancer patients.. Bulletin du Cancer 96(Suppl. 2): 81-89, 2016

Chemotherapy of breast cancer treatment of metastatic, recurrent or inoperable breast cancer. South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie 13(3): 121-127, 1975

Adjuvant chemotherapy for breast cancer: a cost-utility analysis of FEC-D vs. FEC 100. Breast Cancer Research and Treatment 111(2): 261-267, 2007

Cost-Effectiveness and Cost-Utility of Granulocyte Colony-Stimulating Factors in the Primary Prophylaxis of Chemotherapy Induced Febrile Neutropenia (FN) in Breast Cancer Patients in Greece: A Comparative Analysis. Value in Health 17(7): A633, 2014

Cost-Utility Analysis of Trastuzumab in Treatment Of Metastatic Her2-Positive Breast Cancer in Vietnam. Value in Health 17(7): A643, 2014

Development and evaluation of a decision aid for patients considering first-line chemotherapy for metastatic breast cancer. Health Expectations 11(1): 35-45, 2008

Utility of CPT-11 as salvage chemotherapy for progressive or recurrent breast cancer patients with multiple drug resistance. Gan to Kagaku Ryoho. Cancer and ChemoTherapy 37(6): 1095-1099, 2010