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Can Sequential Administration Minimise the Cost of High Dose Chemotherapy?

An Economic Assessment in Inflammatory Breast Cancer

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Abstract

Objective: To evaluate the potential cost savings of using sequential high dose chemotherapy (HDC), with granulocyte colony-stimulating factor (filgrastim) and stem cell support, rather than single course administration of HDC with bone marrow transplantation (BMT) or peripheral blood stem cell transplantation (PBSCT).

Perspective: French public hospital perspective.

Methods: Direct medical costs of sequential treatment, estimated on the basis of physical quantities of resources consumed by 95 patients with inflammatory breast cancer (IBC) included in a French pilot multicentric trial (PEGASE 02), were compared with those of historical control groups of patients treated with single course HDC, either with BMT (n = 27) or PBSCT (n = 14). Costs were evaluated in 1998 French francs (1 € = 6.55957 French francs).

Results: The total cost of sequential HDC was significantly lower than that for single course HDC both with BMT (−29%; €22 755 vs €32 284; p < 0.001) or PBSCT (−16%; €22 755 vs €27209; p = 0.026). This was mainly due to a reduction in the length of hospitalisation in transplantation units.

Conclusion: According to our results, economic arguments cannot be used against the widespread use of sequential HDC for patients with IBC. However, further economic evaluations based on overall and disease-free survivals alongside a randomised clinical trial are still needed to definitively establish the cost effectiveness of sequential administration of HDC.

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Notes

  1. Pathological response is evaluated by tumour reduction after chemotherapy on pathological examination (a complete response is defined as the absence of any evident residual macroscopic and microscopic tumour.)

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Acknowledgements

This work was supported by special grants from the French Minister of Health (Hospital Program for Clinical Research-PHRC) and the Ligue Nationale Contre le Cancer, as was the whole PEGASE program, which is also supported by the French Federation of Anti-Cancer Center (FNCLCC). Additional grants were given by Amgen France, Produits Roche, Pharmacia-Upjohn and Wyeth-Lederle. The authors have provided no information on conflicts of interest directly relevant to the content of this study.

The authors are grateful to the Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC), who promoted this study. We thank all the participating institutions and the members of the ‘Economic/Quality of Life/Intensive Therapy’ Group of the FNCLCC. The participating institutions were: Institut Paoli-Calmettes, Marseilles; Institut Curie, Paris; Centre René Huguenin, Saint-Cloud; Centre Val d’Aurelle, Montpellier; Centre Claudius Régaud, Toulouse; Centre François Baclesse, Caen; CHU A Morvan, Brest; Hôpital Bretonneau, Tours; Hôpital Pasteur, Colmar; CHU Henri Mondor, Créteil; Institut Jean Godinot, Reims; Centre Paul Papin, Angers; Centre Jean Perrin, Clermont-Ferrand; Centre René Dubos, Pontoise; Hôpital Nord, Saint-Etienne; CHU A. Michallon, Grenoble; and the Centre Antoine Lacassagne, Nice.

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Authors and Affiliations

  1. Inserm Research Unit 379, Institut Faoli-Calmettes, 232, Boulevard de Sainte Marguerite, 13 273, Marseilles Cedex 9, France

    Patricia Marino, Anne-Gaelle Le Corroller, Jean-Paul Moatti & Patrice Viens

  2. Institut Curie, Paris, France

    Thao Palangié & Alain Livartowski

  3. Centre René Huguenin, Saint Cloud, France

    Maud Janvier

  4. Centre Paul Lamarque, Montpellier, France

    Michel Fabbro

  5. Centre Claudius Regaud, Toulouse, France

    Laurent Molinier

  6. Centre François Baclesse, Caen, France

    Thierry Delozier

  7. Institut Paoli-Calmettes, Marseilles, France

    Patrice Viens

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  1. Patricia Marino
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  2. Anne-Gaelle Le Corroller
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Correspondence to Patricia Marino.

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Marino, P., Le Corroller, AG., Palangié, T. et al. Can Sequential Administration Minimise the Cost of High Dose Chemotherapy?. Pharmacoeconomics 21, 807–818 (2003). https://doi.org/10.2165/00019053-200321110-00004

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  • DOI: https://doi.org/10.2165/00019053-200321110-00004

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