Corporació Sanitària Parc Taulí, Barcelona, Spain.
Clin Transl Oncol. 2010 Oct;12(10):692-700. doi: 10.1007/s12094-010-0579-4.
Our aim was to evaluate the cost-effectiveness of docetaxel versus weekly paclitaxel regimen in patients with metastatic breast cancer previously treated with anthracycline from the Spanish National Health Service (NHS) perspective.
A Markov model with a 21-day cycle duration was developed to estimate total treatment-related costs and clinical benefits over 5 years of docetaxel (100 mg/m²) and weekly paclitaxel (80 mg/m²). Patient data were obtained from the Randomized Phase III Study of Docetaxel Compared with Paclitaxel in Metastatic Breast Cancer (TAX- 311) and Anglo-Celtic IV trials. Utilities were obtained from literature, and unitary costs (€2009) from a Spanish health-cost database and the Catalogue of Medicines. Cost and benefits [life-years gained (LYG) and quality-adjusted life years (QALY)] were discounted at 3%. Sensitivity analyses were performed.
Docetaxel yields higher health benefits (1.83 LYG; 1.08 QALY) than paclitaxel (1.46 LYG; 0.84 QALY). Global costs (treatment, concomitant medication, adverse events management, progression, best supportive care, and end of life phase) per patient were €20,052 and €9,982 with docetaxel and paclitaxel, respectively. Incremental cost-effectiveness ratio (ICER) of docetaxel versus paclitaxel was €190/LYG and €295/QALY. Based on a €30,000/QALY threshold, docetaxel has 99% probability of being cost-effective. ICER was mostly sensitive to hazard ratio (HR) (when varied from 1.46 to 1.09; €3,517/ QALY), discount over the ex-lab price of Taxol® (75%; €6,396/QALY) and granulocyte colony-stimulating factor (G-CSF) prophylactic treatment (when administered in 60% of cycles instead of 100%; cost saving). Variations in other inputs, such as time horizon (3-10 years), discount rate (0-5%), or adverse event cost (± 25%) were shown not to have relevant influence on the results.
Compared to weekly paclitaxel, docetaxel therapy is cost effective for treating metastatic breast cancer patients.
本研究旨在从西班牙国家医疗服务体系（NHS）的角度，评估多西他赛对比每周紫杉醇方案在既往接受蒽环类药物治疗的转移性乳腺癌患者中的成本效益。
采用 21 天周期的 Markov 模型，评估多西他赛（100mg/m²）和每周紫杉醇（80mg/m²）5 年的总治疗相关成本和临床获益。患者数据来自多西他赛对比紫杉醇治疗转移性乳腺癌的随机 III 期研究（TAX-311）和 Anglo-Celtic IV 试验。效用值来自文献，单位成本（2009 欧元）来自西班牙医疗成本数据库和药品目录。成本和获益（获得的生命年[LYG]和质量调整生命年[QALY]）贴现率为 3%。进行敏感性分析。
多西他赛比紫杉醇（LYG：1.83；QALY：1.08）产生更高的健康获益。每位患者的全球成本（治疗、伴随药物、不良事件管理、进展、最佳支持治疗和生命终末期）分别为多西他赛 20052 欧元和紫杉醇 9982 欧元。多西他赛对比紫杉醇的增量成本效益比（ICER）为 190 欧元/LYG 和 295 欧元/QALY。基于 30000 欧元/QALY 的阈值，多西他赛有 99%的概率具有成本效益。ICER 主要对风险比（HR）敏感（当 HR 从 1.46 变为 1.09 时，ICER 为 3517 欧元/QALY）、Taxol®（泰素）出厂价的折扣（75%；6396 欧元/QALY）和粒细胞集落刺激因子（G-CSF）预防性治疗（当 60%的周期而非 100%使用时，节省成本）。其他输入（如时间范围[3-10 年]、贴现率[0-5%]或不良事件成本[±25%]）的变化对结果没有明显影响。
与每周紫杉醇相比，多西他赛治疗转移性乳腺癌患者具有成本效益。
