Efficacy and cost-effectiveness of adjuvant chemotherapy in women with node-negative breast cancer: a decision-analysis model
Hillner B E, Smith T J
Record Status
This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.
Health technology
Adjuvant chemotherapy.
Type of intervention
Treatment
Economic study type
Cost-utility analysis.
Study population
45 year old women and 60 year old women.
Setting
The study was carried out in the USA.
Dates to which data relate
Price related to 1989.
Source of effectiveness data
Review of studies.
Modelling
Epidemiological cohort model (model of survival and disease).
Measure of benefits used in the economic analysis
QALYs. Nine descriptive states were used for the health state description. Clinician, and other health worker values were used to assess the health states.
Direct costs
Direct costs were to the health service and included: chemotherapy (drug, minor and major toxicity, death), scheduled follow-up while well, [first, second and third recurrences]-survived and fatal. Price information related to 1989.
Currency
US dollars ($). In the DH Register of Cost-Effectiveness Studies, the original results were converted to UK pounds sterling () using GDP purchasing power parities and reflated to 1991 using the NHS pay and prices index.
Sensitivity analysis
Sensitivity analysis was carried out using the method of single parameter variation.
Estimated benefits used in the economic analysis
Outcome duration was life long and treatment side-effects were included. Intervention yielded 10.72 and 9.24 QALYs for the 45 and 60 year old groups respectively. The incremental QALYs were 0.14 and 0.12 for the two groups respectively. Benefits were discounted at 5%.
Synthesis of costs and benefits
Cost duration was life long. Incremental cost per QALYfor adjuvant chemotherapy in 45 year old women was 33600, and in 60 year old women was 39300 (costs and benefits discounted at 5%).
CRD Commentary
(This commentary was not written by CRD, but by the authors of the DH Register.) 1) Two more optimistic scenarios are given, but the one reported here (no improvement in overall survival) reflects current evidence. 2) Benefits from chemotherapy come from delaying recurrence. 3) Costs are based on charges. 4) The paper has not tabulated source trial data and so the quality of evidence and validity of assumptions are uncertain. 5) There were no health omissions.
Bibliographic details
Hillner B E, Smith T J. Efficacy and cost-effectiveness of adjuvant chemotherapy in women with node-negative breast cancer: a decision-analysis model. New England Journal of Medicine 1991; 324(3): 160-168
Age Factors; Breast Neoplasms /drug therapy /mortality; Cost-Benefit Analysis; Decision Trees; Drug Therapy /economics; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Lymph Nodes /pathology; Lymphatic Metastasis; Middle Aged; Neoplasm Recurrence, Local; Patient Acceptance of Health Care; Quality of Life