Dear Sirs,

In their interesting review [1], Pouwels et al. quoted our article an Italian cost-effectiveness analysis of paclitaxel albumin (nab-paclitaxel) versus conventional paclitaxel for metastatic breast cancer patients [2].

While we thank Pouwels et al. for their interest in our research, we are really surprised about their statement at page 488 “Lazzaro et al. was unclear about how treatment effectiveness has modeled [39].” [1]. Indeed (page 126), we clearly reported that “Transition probabilities among Markov model states were estimated via the Weibull distribution. The Weibull distribution was used to generalize progression-free survival (PFS) and OS, in order to extrapolate survival in the model beyond the follow-up of the abovementioned RCT that compared nab-paclitaxel versus conventional paclitaxel.11” [2].

Therefore, what is unclear about our approach, as PFS and OS survival, measured in Life-Year Saved (LYS), were the effectiveness outcomes, to be translated into Quality-Adjusted Life Years for cost-utility analysis [3, 4].

In addition:

  1. (1)

    Table 1 (page 490): Pouwels et al. claimed that second line treatment was not mentioned in our paper [1]. However (page 126), we stated that “…in MBC patients as a second-line treatment whenever standard, anthracycline-containing therapy is not indicated.13”[2].

  2. (2)

    Table 2 (page 492): Pouwels et al. claimed that incremental LYS by Nab-paclitaxel vs. paclitaxel were not mentioned in our paper [1], whereas they were clearly reported (page 130) “…nab-paclitaxel… saves 0.265 life years more than conventional paclitaxel (1.439 versus 1.173).”[2].

While the role of review articles in health economics and related research fields is of paramount importance, the strength of their recommendations is obviously conditional on a careful description of the studies retrieved from the literature.