1Directorate of Pharmaceutical Production and Distribution, Directorate General of Pharmaceuticals and Medical Devices, Ministry of Health of the Republic of Indonesia, Indonesia.
Clinical Epidemiology and Biostatistics Unit (CE&BU), Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Indonesia.
Asian Pac J Cancer Prev. 2022 Apr 1;23(4):1147-1154. doi: 10.31557/APJCP.2022.23.4.1147.
Breast cancer is the deadliest cancer among women worldwide including Indonesia. Both FAC and Taxane-based chemotherapies are often used for patients with early node-positive breast cancer. However, the study regarding the cost-effectiveness of those regiments is still rare. This study aims to analyze the cost-effectiveness of Taxane versus FAC in the Indonesia setting.
Twenty-four patients with stage I-IIIA breast cancer who had received surgery, FAC or Taxane-based adjuvant chemotherapy, and radiation were included in this study. Health-related quality of life was assessed using INA-BCHRQoL. INA-BCHRQoL was mapped to the EuroQoL 5D (EQ-5D) index calculator to get the utility score. All direct cost was retrieved from electronic medical records and hospital information system. Whereas, a questionnaire was designed to collect information about society cost from patients. ICER was counted to summarize the cost-effectiveness of two chemotherapy regiments (Taxane versus FAC). A sensitivity analysis was done to assess the uncertainty result.
The results showed there was no significant difference between the score of quality of life and utility in respondents who received FAC chemotherapy and Taxane-based chemotherapy. However, in terms of cost, Taxane was 6.5 times higher than the FAC group per patient for chemotherapy drugs only. Moreover, the total cost of treatments in Taxane-based chemotherapy was approximately 3.7 times more costly than the counterpart in the FAC arm (p=0.000). Taxane-based chemotherapy dominated with ICER IDR 765.213.092 per QALY gained. Overall, FAC was found more cost-effective compared to the Taxane regiment.
FAC represents the value of money compared to Taxane-based for breast cancer patients with stage I-IIIA in Indonesia.
乳腺癌是全球范围内女性中最致命的癌症，包括印度尼西亚。FAC 和基于紫杉烷的化疗通常用于早期淋巴结阳性乳腺癌患者。然而，关于这些方案的成本效益研究仍然很少。本研究旨在分析印度尼西亚紫杉烷与 FAC 方案的成本效益。
本研究纳入了 24 名接受手术、FAC 或基于紫杉烷的辅助化疗和放疗的 I 期-IIIA 期乳腺癌患者。采用 INA-BCHRQoL 评估健康相关生活质量。将 INA-BCHRQoL 映射到 EuroQoL 5D（EQ-5D）指数计算器，以获得效用评分。所有直接成本均从电子病历和医院信息系统中检索。而有关社会成本的信息则通过设计问卷从患者处收集。计算增量成本效益比（ICER）以总结两种化疗方案（紫杉烷与 FAC）的成本效益。进行敏感性分析以评估不确定性结果。
结果表明，接受 FAC 化疗和基于紫杉烷化疗的患者的生活质量评分和效用评分无显著差异。然而，就成本而言，仅化疗药物，紫杉烷组每个患者的成本是 FAC 组的 6.5 倍。此外，基于紫杉烷的化疗治疗总成本比 FAC 组高约 3.7 倍（p=0.000）。基于紫杉烷的化疗方案具有 ICER 为每获得一个质量调整生命年（QALY）需要花费 765.213.092 印度尼西亚盾（IDR）。总体而言，FAC 方案比 Taxane 方案更具成本效益。
在印度尼西亚，对于 I 期-IIIA 期乳腺癌患者，FAC 方案比基于紫杉烷的方案更具成本效益。
