Skip to main content

Advertisement

SpringerLink
Log in

Cost-effectiveness analysis of adjuvant docetaxel, doxorubicin, and cyclophosphamide (TAC) for node-positive breast cancer: modeling the downstream effects

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose BCIRG 001 demonstrated prolonged disease-free (DFS) and overall survival (OS) but increased toxicity for adjuvant docetaxel, doxorubicin, and cyclophosphamide (TAC) versus 5-fluorouracil, doxorubicin, cyclophosphamide (FAC) in women with node positive breast cancer (BC). This study evaluates quality-adjusted survival and cost-effectiveness of adjuvant TAC versus FAC, taking downstream decisions and events into account, including palliative chemotherapy with taxanes. Methods We developed a Markov model for a cohort of women with node positive BC eligible for adjuvant anthracyclines. Data input included clinical and resource utilization data collected prospectively from BCIRG 001. Treatment decisions and outcomes with disease recurrence were based on a systematic literature review with validity reviewed by a national panel of Canadian BC oncologists. Direct costs for resource utilization following Canadian practice patterns were included. Unit costs were obtained from provincial cost list and published drug list prices. Utility scores were derived from the literature. An incremental cost-effectiveness ratio (ICER) in cost per quality-adjusted life-years (QALY) gained for TAC versus FAC was calculated. Results For 1,000 women with node positive BC, the model showed that TAC would lead to a gain of 313 QALY (370 life years) at an additional cost of $5.8 Million Canadian dollars (Cdn) compared to FAC, over a 10-year time horizon. The ICER of TAC versus FAC was $18,505.54 Cdn per QALY gained. Sensitivity analyses supported the robustness of the model. By one-way sensitivity analyses of over 50 model variables, 95% of the cumulative ICER variation was from $6,000 to $28,000 Cdn/QALY. By multivariate Monte Carlo simulation, there was a 70% probability that the ICER would be under $50,000 CdN/QALY. Conclusion For women with node positive BC, TAC improves DFS and OS compared to FAC and is a cost-effective adjuvant chemotherapy strategy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Canadian Cancer Society/National Cancer Institute of Canada (2006) Canadian cancer statistics 2006, Toronto, Canada

  2. Harris JR, Lippman ME, Morrow M et al (1996) Prognostic and predictive factors in diseases of the breast. Lippincott-Raven Publishers, Philadelphia, pp 461–485

    Google Scholar 

  3. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2005) Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomized trials. Lancet 365:1687–1717

    Article  Google Scholar 

  4. Adjuvant Therapy for Breast Cancer (2000) NIH consensus statement online. November 1–3; cited 2006, June 21, 17(4):1–23

  5. O’Shaughnessy J (2005) Extending survival with chemotherapy in metastatic breast cancer. Oncologist 10(suppl 3):20–29

    Article  PubMed  CAS  Google Scholar 

  6. Martin M, Pienkowski T, Mackey J et al (2005) Adjuvant docetaxel for node-positive breast cancer. N Engl J Med 352:2302–2313

    Article  PubMed  CAS  Google Scholar 

  7. Blum JL, Dieras V, Mucci Lo Russo P et al (2001) Multicenter, phase II study of capecitabine in taxane-pretreated metastatic breast carcinoma patients. Cancer 92:1759–1768

    Article  PubMed  CAS  Google Scholar 

  8. Zelek I, Barthier S, Riofrio M et al (2001) Weekly vinorelbine is an effective palliative regimen after failure with anthracyclines and taxanes in metastatic breast carcinoma. Cancer 92:2267–2272

    Article  PubMed  CAS  Google Scholar 

  9. Jones S, Erban J, OVermoyer B et al (2003) Randomized trial comparing docetaxel and paclitaxel in patients with metastatic breast cancer. Presented at the 26th annual San Antonio breast cancer symposium

  10. Papaldo P, Fabi A, Nardoni C et al (2003) Trastuzumab improves the prognosis in HER2-positive when compared with HER2-negative patients. Trastuzumab plus vinorelbine in HER2-positive versus vinorelbine alone in HER2-negative metastatic breast cancer patients. Breast Cancer Res Treat 82(suppl 1):S9

    Google Scholar 

  11. Slamon DJ, Leyland-Jones B, Shak S et al (2001) Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that overexpresses HER2. N Engl J Med 344:783–792

    Article  PubMed  CAS  Google Scholar 

  12. Martin M, Pienkowski T, Mackey J et al (2003) TAC improves disease free survival and overall survival over FAC in node positive early breast cancer patients. BCIRG 001: 55 months followup. Presented at the 26th annual San Antonio breast cancer symposium

  13. Alberta Vital Statistics 2000–2003

  14. Bedwinek J (1994) Natural history and management of isolated local-regional recurrence following mastectomy. Semin Radiat Oncol 4:260–269

    Article  PubMed  Google Scholar 

  15. Clemons M, Danson S, Hamilton T et al (2001) Locoregionally recurrent breast cancer: incidence, risk factors and survival. Cancer Treat Rev 27:67–82

    Article  PubMed  CAS  Google Scholar 

  16. Zielilnski CC (2003) Treatment choices for second-line chemotherapy of metastatic breast cancer. Breast Cancer Res Treat 81(suppl 1):S33–S36

    Article  Google Scholar 

  17. Sonnenberg FA, Beck JR (1993) Markov models in medical decision making: a practical guide. Med Decis Making 13:322–338

    Article  PubMed  CAS  Google Scholar 

  18. Crown J, Dieras V, Kaufmann M et al (2002) Chemotherapy for metastatic breast cancer—report of a European expert panel. Lancet Oncol 3:719–727

    Article  PubMed  CAS  Google Scholar 

  19. Fassbender K, Fainsinger R, Brenneis C et al (2005) Utilization and costs of the introduction of system-wide palliative care in Alberta, 1993–2000. Palliat Med 19:513–520

    Article  PubMed  Google Scholar 

  20. Brown RE, Hutton J, Burrell A (2001) Cost effectiveness of treatment options in advanced breast cancer in the UK. Pharmacoeconomics 19:1091–1102

    Article  PubMed  CAS  Google Scholar 

  21. Hayman JA, Hillner BE, Harris JR et al (2000) Cost-effectiveness of routine radiation therapy following conservative surgery for early-stage breast cancer. J Clin Oncol 16:1022–1029

    Google Scholar 

  22. Leung PP, Tannock IF, Oza AM et al (1999) Cost-utility analysis of chemotherapy using paclitaxel, docetaxel, or vinorelbine for patients with anthracycline-resistant breast cancer. J Clin Oncol 17:3082–3090

    PubMed  CAS  Google Scholar 

  23. Brown RE, Hutton J (1998) Cost-utility model comparing docetaxel and paclitaxel in advanced breast cancer patients. Anticancer Drugs 9:899–907

    Article  PubMed  CAS  Google Scholar 

  24. Martin SC, Gagnon DD, Zhang L et al (2003) Cost-utility analysis of survival with epoetin-alpha versus placebo in stage IV breast cancer. Pharmacoeconomics 21:1153–1169

    Article  PubMed  Google Scholar 

  25. Drummond MF, Scupher MJ, Torrance GW et al (2005) Methods for the economic evaluation of health care programmes, 3rd edn. Oxford University press, Oxford

    Google Scholar 

  26. Case Mix number 297, Alberta Health and Wellness, costs in Alberta, 2002

  27. Hurley SF, Huggins RM, Snyder RD et al (1992) The cost of breast cancer recurrences. Br J Cancer 65:449–455

    PubMed  CAS  Google Scholar 

  28. Martin M, Lluch A, Segui MA (2004) Prophylactic growth factor (GF) support with adjuvant docetaxel, doxorubicin, and cyclophosphamide (TAC) for node-negative breast cancer (BC): an interim safety analysis of the GEICAM 9805 study. J Clin Oncol; 22(suppl 14):620. Proc ASCO (Post-Meeting Edition)

    Google Scholar 

  29. Piccart-Gebhart MJ, Procter M, Leyland-Jones B et al (2005) Trustuzumab after adjuvant chemotherapy in HER2-positive breast cancer. N Engl J Med 353:1659–1672

    Article  PubMed  CAS  Google Scholar 

  30. Romond EH, Perez EA, Bryant J et al (2005) Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med 353:1673–1684

    Article  PubMed  CAS  Google Scholar 

  31. TreeAge software Inc. (2005) Williamstown, MA

  32. Hirth RA, Chernew ME, Miller E et al (2000) Willingness to pay for a quality-adjusted life year: in search of a standard. Health Econ 20:332–342

    CAS  Google Scholar 

  33. Greene FL, Page DL, Fleming ID et al (2002) AJCC cancer staging handbook, 6th edn. Springer, New York

    Google Scholar 

  34. Smith TJ, Khatcheressian J, Lyman GH (2006) 2006 update of recommendations for the use of white blood cell growth factors: an evidence-based, clinical practice guidelines. J Clin Oncol 24:3187–3205

    Article  PubMed  CAS  Google Scholar 

  35. Hillner BE, Weeks JC, Desch CE et al (2000) Pamidronate in prevention of bone complications in metastatic breast cancer: a cost-effectiveness analysis. J Clin Oncol 18:72–79

    PubMed  CAS  Google Scholar 

  36. Neyt M, Albrecht J, Cocquyt V (2006) An economic evaluation of Herceptin in adjuvant setting: the Breast Cancer International Research Group 006 trial. Ann Oncol 17:381–390

    Article  PubMed  CAS  Google Scholar 

  37. Elkin EB, Weinstein MC, Winer EP et al (2004) HER-2 testing and trastuzumab therapy for metastatic breast cancer: a cost-effectiveness analysis. J Clin Oncol 22:854–863

    Article  PubMed  Google Scholar 

  38. Hillner BE, Schrag D, Sargent DJ et al (2005) Cost-effectiveness projections of oxaliplatin and infusional fluorouracil versus irinotecan and bolus fluorouracil in first-line therapy for metastatic colorectal carcinoma. Cancer 104:1871–1084

    Article  PubMed  CAS  Google Scholar 

  39. Rocconi RP, Case AS, Straughn JM et al (2006) Role of chemotherapy for patients with recurrent platinum-resistant advanced epithelial ovarian cancer: a cost-effectiveness analysis. Cancer 107:536–543

    Article  PubMed  CAS  Google Scholar 

  40. Ubel PA, Hirth RA, Chernew ME et al (2003) What is the price of life and why doesn’t it increase at the rate of inflation? Arch Intern Med 163:1637–1641

    Article  PubMed  Google Scholar 

  41. Hayes DF, Thor AD, Dressler LG et al (2007) HER2 and response to paclitaxel in node-positive breast cancer. N Engl J Med 357:1496–1506

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

This study has been supported by a research grant from sanofi-aventis, Canada. The authors would like to acknowledge the work of Linda Harris, librarian at Cross Cancer Institute, who performed the systematic literature searching.

Author information

Authors and Affiliations

  1. Cross Cancer Institute, 11560 University Avenue, Edmonton, AB, Canada, T6G 1Z2

    Heather-Jane Au

  2. Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada

    Heather-Jane Au, Kamran Golmohammadi, Konrad Fassbender & Philip Jacobs

  3. Queen Elizabeth II Health Sciences Centre, Halifax, Canada

    Tallal Younis

  4. Ottawa Hospital Integrated Cancer Centre Program, Ottawa, Canada

    Shailendra Verma

  5. Vancouver Cancer Centre, Vancouver, Canada

    Stephen Chia

Authors
  1. Heather-Jane Au
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kamran Golmohammadi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tallal Younis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shailendra Verma
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stephen Chia
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Konrad Fassbender
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Philip Jacobs
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Heather-Jane Au.

Additional information

An invited commentary to this article can be found at doi:10.1007/s10549-008-0142-y.

Electronic Supplementary Material

Rights and permissions

Reprints and permissions

About this article

Cite this article

Au, HJ., Golmohammadi, K., Younis, T. et al. Cost-effectiveness analysis of adjuvant docetaxel, doxorubicin, and cyclophosphamide (TAC) for node-positive breast cancer: modeling the downstream effects. Breast Cancer Res Treat 114, 579–587 (2009). https://doi.org/10.1007/s10549-008-0034-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-008-0034-1

Keywords

Search

Navigation