Analytical approach:
The analysis was based on a Markov model, with a time horizon of 10 years. The authors stated that it was conducted from the perspective of the third-party payer.
Effectiveness data:
The key evidence on overall survival, disease-free survival (DFS), and drug adverse effects was from a randomised trial conducted in the USA (Jones, et al. 2009, see 'Other Publications of Related Interest' below for bibliographic details). This trial randomised 1,016 patients with node-negative or node-positive breast cancer to four cycles of adjuvant docetaxel or doxorubicin, with cyclophosphamide. Mortality was from Canadian life tables and other data were from published sources.
Monetary benefit and utility valuations:
The utility values for the health conditions were from published literature.
Measure of benefit:
Quality-adjusted life-years (QALYs) were the summary benefit measure and were discounted at an annual rate of 3%.
Cost data:
The economic analysis included the initial costs of chemotherapy and the later costs of adverse events, follow-up, and relapse. The chemotherapy costs were from the authors’ institution, as reported in another publication. They included the costs of the drugs, supportive care other medications, diagnostics, and other health care resources. The later costs were from published sources. All costs were in Canadian dollars (CAD) and were discounted at an annual rate of 3%. The price year was 2008.
Analysis of uncertainty:
Deterministic one-way sensitivity analyses were carried out on all the model inputs, using ranges of values from published sources or authors’ opinions. Alternative scenarios for selected inputs were considered. A first-order probabilistic analysis considered the overall uncertainty in the model outcomes and generated cost-effectiveness acceptability curves.