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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

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Abstract

Purpose

We assessed the cost-effectiveness of a risk model-guided (RMG) antiemetic prophylaxis strategy compared with the physician’s choice (PC) strategy in patients receiving chemotherapy for early-stage breast cancer.

Methods

We conducted a cost-utility analysis based on a published randomized controlled trial of 324 patients with early-stage breast cancer undergoing chemotherapy at two Canadian cancer centers. Patients were randomized to receive their antiemetic treatments according to either predefined risk scores or the treating physician’s preference. Effectiveness was measured as quality-adjusted life years (QALYs) gained. Cost and utility data were obtained from the Canadian published literature. We used generalized estimating equations to estimate the incremental cost-effectiveness ratios (ICERs) and 95% confidence intervals (CIs) over a range of willingness-to-pay values. The lower and upper bounds of the 95% CIs were used to characterize the statistical uncertainty for the cost-effectiveness estimates and construct cost-effectiveness acceptability curves.

Results

From the health care system’s perspective, the RMG strategy was associated with greater QALYs gained (0.0016, 95% CI 0.0009, 0.0022) and higher cost ($49.19, 95% CI $24.87, $73.08) than the PC strategy, resulting in an ICER of $30,864.28 (95% CI $14,718.98, $62,789.04). At the commonly used threshold of $50,000/QALY, the probability that RMG prophylaxis is cost-effective was >94%; this probability increased with greater willingness-to-pay values.

Conclusion

The risk-guided antiemetic prophylaxis is an economically attractive option for patients receiving chemotherapy for early-stage breast cancer. This information supports the implementation of risk prediction models to guide chemotherapy-induced nausea and vomiting prophylaxis in clinical practices.

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Authors’ contributions

KT, LV, SM, DF, and MC contributed to the conception of the study question and design. DC, JH, and GD guided the analyses. LV and ZW helped with data management. KT performed the analyses and prepared the first draft of the manuscript. All authors reviewed and approved the manuscript.

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Authors and Affiliations

  1. Ottawa Hospital Research Institute, The Ottawa Hospital, General Campus, 501 Smyth Road, PO Box 201B, Ottawa, ON, K1H 8L6, Canada

    Kednapa Thavorn, Dean Fergusson & Mark Clemons

  2. School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada

    Kednapa Thavorn, Doug Coyle, Dean Fergusson & Mark Clemons

  3. Institute for Clinical Evaluative Sciences (ICES uOttawa), Ottawa, ON, Canada

    Kednapa Thavorn

  4. Department of Public Health Sciences, University of California, Davis, CA, USA

    Jeffrey S. Hoch

  5. Division of Medical Oncology and Department of Medicine, University of Ottawa, Ottawa, Canada

    Lisa Vandermeer, Sasha Mazzarello & Mark Clemons

  6. Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada

    Zhou Wang

  7. Statistical Consultant, Toronto, ON, Canada

    George Dranitsaris

  8. Department of Medicine, University of Ottawa, Ottawa, Canada

    Dean Fergusson

  9. Department of Surgery, University of Ottawa, Ottawa, Canada

    Dean Fergusson

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  1. Kednapa Thavorn
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  2. Doug Coyle
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Corresponding author

Correspondence to Kednapa Thavorn.

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The study protocol has been approved by local institutional review boards.

Conflict of interest

The authors declare that they have no conflicts of interest.

Funding

This study was conducted without funding.

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Thavorn, K., Coyle, D., Hoch, J.S. et al. 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. Support Care Cancer 25, 2505–2513 (2017). https://doi.org/10.1007/s00520-017-3658-z

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  • DOI: https://doi.org/10.1007/s00520-017-3658-z

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