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Cost-effectiveness analyses of docetaxel versus paclitaxel once weekly in patients with metastatic breast cancer in progression following anthracycline chemotherapy, in Spain |
Frias C, Cortes J, Segui MA, Oyaguez I, Casado MA |
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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. CRD summary The objective was to evaluate the cost-effectiveness of docetaxel every 21 days, compared with weekly paclitaxel, for patients with metastatic breast cancer, which had been treated with anthracycline. The authors concluded that, compared with weekly paclitaxel, docetaxel was cost-effective. The study methods were adequate, but expert opinion was needed for a considerable proportion of the effectiveness and resource use data, and the conclusions should be considered to be uncertain. Type of economic evaluation Cost-effectiveness analysis, cost-utility analysis Study objective The objective was to evaluate the cost-effectiveness of docetaxel every 21 days, compared with weekly paclitaxel, for patients with metastatic breast cancer, which had been treated with anthracycline. Interventions The two interventions were 100mg per m² docetaxel administered as an intravenous infusion every 21 days, and 80mg per m² paclitaxel administered intravenously once a week. Location/setting Spain/in-patient secondary care. Methods Analytical approach:A Markov model was developed to simulate the costs and outcomes of the two interventions over five years. The authors reported that the perspective was that of the Spanish National Health Service. Effectiveness data:The clinical and effectiveness data were from published studies and expert opinion. The model's underlying assumptions and missing information were derived by consultation with a group of oncology clinicians, pharmacists, and health economists. The main clinical effectiveness estimates were the hazard ratios for time to progression and death. These estimates were from a clinical trial that compared paclitaxel three times weekly with docetaxel (Jones, et al. 2005, see 'Other Publications of Related Interest' below for bibliographic details). Monetary benefit and utility valuations:The utility estimates were from published studies. Measure of benefit:Life-years gained and quality-adjusted life-years (QALYs) gained were the summary measures. As benefits could be generated over five years, future benefits were discounted at an annual rate of 3%. Cost data:The direct costs included treatment and administration of the interventions (dosage, preparation, administration, and pre-medication); blood transfusion; other treatments (erythropoietin, capecitabine, granulocyte colony-stimulating factor, gemcitabine, and vinorelbine); diagnosis of progression; best supportive care; end of life care; and the treatment of adverse events (pain, asthenia, nausea, infection, and neutropenia). The resource use was from published studies and the clinical advisory group. The unit costs were from published Spanish sources. The price year was 2009. Future costs were discounted at an annual rate of 3% and all costs were reported in Euros (EUR). Analysis of uncertainty:To test how robust the results were, the authors undertook one-way, multivariate, and probabilistic sensitivity analyses. For the probabilistic analyses, distributions were fitted to each model parameter, and a second-order Monte Carlo simulation, with 5,000 runs, was completed. The results were plotted on a cost-effectiveness acceptability curve, with a willingness-to-pay threshold of EUR 30,000 per life-year or QALY gained. Results The average life-years gained were 1.83 for docetaxel and 1.46 for once-weekly paclitaxel. The average QALYs gained were 1.08 for docetaxel and 0.84 for paclitaxel. The average cost per patient was EUR 20,052 for docetaxel and EUR 19,981 for paclitaxel. Compared with once-weekly paclitaxel, the incremental cost-effectiveness ratio for docetaxel was EUR 190 per life-year gained and the incremental cost-utility ratio was EUR 295 per QALY gained. The probabilistic sensitivity analyses showed that, at a willingness-to-pay threshold of EUR 30,000, docetaxel was cost-effective over once-weekly paclitaxel in 99% of simulations. Authors' conclusions The authors concluded that, compared with weekly paclitaxel, docetaxel was cost-effective for treating metastatic breast cancer patients. CRD commentary Interventions:The interventions were reported appropriately. Effectiveness/benefits:The clinical and effectiveness data were from published studies and expert opinion. The authors reported the composition of the group that provided opinions, and it included oncologists, pharmacists, and health economists. The main measures of effectiveness were from a multicentre randomised controlled trial, and they are likely to have been internally valid, but paclitaxel was given three times weekly, rather than once weekly as modelled. The authors reported that any bias due to this assumption was tested by overloading the sensitivity analysis, but this may require further investigation. The authors did not report the methods used to identify the relevant clinical and effectiveness data, so it is unclear if all these data were identified and used to inform the model estimates. Costs:The perspective was explicitly reported to be that of the Spanish National Health Service and it appears that all the relevant cost categories and costs were included. The sources for these costs and the resource use were reported. The price year, time horizon, discount rate, and currency were all reported. Analysis and results:The cost and outcome information was synthesised in a Markov model. The details of this model and a diagram were reported. The impact of uncertainty on the model’s results was adequately tested in one-way, multi-way, and probabilistic sensitivity analyses. The authors reported that the main limitation to their study was that the resource use for adverse event management was the opinion of experts rather than prospectively collected cohort data. Concluding remarks:The study methods were adequate, but expert opinion was needed for a considerable proportion of the effectiveness and resource use data, and the conclusions should be considered to be uncertain. Funding Supported by a grant from Sanofi-aventis, manufacturer of docetaxel. Bibliographic details Frias C, Cortes J, Segui MA, Oyaguez I, Casado MA. Cost-effectiveness analyses of docetaxel versus paclitaxel once weekly in patients with metastatic breast cancer in progression following anthracycline chemotherapy, in Spain. Clinical and Translational Oncology 2010; 12(10): 692-700 Other publications of related interest Jones SE, Erban J, Overmoyer B, Budd GT, Hutchins L, Lower E, Laufman L, Sundaram S, Urba WJ, Pritchard KI, Mennel R, Richards D, Olsen S, Meyers ML, Ravdin PM. Randomized phase III study of docetaxel compared with paclitaxel in metastatic breast cancer. Journal of Clinical Oncology 2005; 23: 5542-5551. Indexing Status Subject indexing assigned by NLM MeSH Anthracyclines /therapeutic use; Antineoplastic Agents /economics /therapeutic use; Breast Neoplasms /drug therapy /economics /pathology; Clinical Trials, Phase III as Topic; Cost-Benefit Analysis; Disease Progression; Female; Humans; Markov Chains; Paclitaxel /economics /therapeutic use; Quality-Adjusted Life Years; Randomized Controlled Trials as Topic; Salvage Therapy /economics; Spain; Taxoids /economics /therapeutic use AccessionNumber 22011000018 Date bibliographic record published 09/02/2011 Date abstract record published 28/09/2012 |
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