HOPE Research Centre, Division of Clinical Pharmacology, Sunnybrook Health Sciences Centre, Toronto, ON.
Curr Oncol. 2010 Feb;17(1):7-16. doi: 10.3747/co.v17i1.445.
This economic analysis aimed to determine, from the perspective of a Canadian provincial government payer, the cost-effectiveness of docetaxel (Taxotere: Sanofi-Aventis, Laval, QC) in combination with doxorubicin and cyclophosphamide (TAC) compared with 5-fluorouracil, doxorubicin, and cyclophosphamide (FAC) following primary surgery for breast cancer in women with operable, axillary lymph node-positive breast cancer.
A Markov model looking at two time phases-5-year treatment and long-term follow-up-was constructed. Clinical events included clinical response (based on disease-free survival and overall survival) and rates of febrile neutropenia, stomatitis, diarrhea, and infections. Health states were "no recurrence," "locoregional recurrence," "distant recurrence," and "death." Costs were based on published sources and are presented in 2006 Canadian dollars. Model inputs included chemotherapy drug acquisition costs, chemotherapy administration costs, relapse and follow-up costs, costs for management of adverse events, and costs for granulocyte colony-stimulating factor (G-CSF) prophylaxis. A 5% discount rate was applied to costs and outcomes alike. Health utilities were obtained from published sources.
For TAC as compared with fac, the incremental cost was $6921 per life-year (LY) gained and $6,848 per quality-adjusted life-year (QALY) gained. The model was robust to changes in input variables (for example, febrile neutropenia rate, utility). When G-CSF and antibiotics were given prophylactically before every cycle, the incremental ratios increased to $13,183 and $13,044 respectively.
Compared with FAC, TAC offered improved response at a higher cost. The cost-effectiveness ratios were low, indicating good economic value in the adjuvant setting of node-positive breast cancer patients.
本项经济分析旨在从加拿大省级政府支付者的角度，评估多西紫杉醇（Taxotere：Sanofi-Aventis，Laval，QC）联合多柔比星和环磷酰胺（TAC）与氟尿嘧啶、多柔比星和环磷酰胺（FAC）相比，在女性可手术性、腋窝淋巴结阳性乳腺癌患者中用于初始手术后的成本效益。
构建了一个马尔可夫模型，该模型考虑了两个时间段-5 年治疗和长期随访。临床事件包括临床反应（基于无病生存率和总生存率）和发热性中性粒细胞减少症、口腔炎、腹泻和感染的发生率。健康状况为“无复发”、“局部区域复发”、“远处复发”和“死亡”。成本基于已发表的资料，并以 2006 年加拿大元呈现。模型输入包括化疗药物购置成本、化疗药物管理成本、复发和随访成本、不良事件管理成本以及粒细胞集落刺激因子（G-CSF）预防成本。对成本和结果均应用了 5%的贴现率。健康效用值取自已发表的资料。
与 FAC 相比，TAC 的增量成本为每获得 1 个生命年（LY）增加 6921 加元，每获得 1 个质量调整生命年（QALY）增加 6848 加元。该模型对输入变量的变化具有稳健性（例如，发热性中性粒细胞减少症的发生率、效用值）。当 G-CSF 和抗生素在每个周期前预防性使用时，增量比值分别增加至 13183 加元和 13044 加元。
与 FAC 相比，TAC 具有更好的反应效果，但成本更高。成本效益比很低，表明在淋巴结阳性乳腺癌患者的辅助治疗中具有较好的经济价值。
