An Economic Evaluation of Docetaxel and Paclitaxel Regimens in Metastatic Breast Cancer in the UK
Abstract Background: Paclitaxel and docetaxel have been available for the treatment of metastatic breast cancer (MBC) since the 1990s. However, until very recently, comparisons between these two drugs have been difficult due to lack of direct comparative clinical evidence and differences in trial pa...
Ausführliche Beschreibung
Autor*in: |
Benedict, Ágnes [verfasserIn] Cameron, David A. [verfasserIn] Corson, Hélène [verfasserIn] Jones, Stephen E. [verfasserIn] |
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E-Artikel |
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Sprache: |
Englisch |
Erschienen: |
2009 |
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Schlagwörter: |
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Übergeordnetes Werk: |
Enthalten in: PharmacoEconomics - Berlin [u.a.] : Springer, 1992, 27(2009), 10 vom: Okt., Seite 847-859 |
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Übergeordnetes Werk: |
volume:27 ; year:2009 ; number:10 ; month:10 ; pages:847-859 |
Links: |
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DOI / URN: |
10.2165/10899510-000000000-00000 |
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Katalog-ID: |
SPR033340315 |
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520 | |a Abstract Background: Paclitaxel and docetaxel have been available for the treatment of metastatic breast cancer (MBC) since the 1990s. However, until very recently, comparisons between these two drugs have been difficult due to lack of direct comparative clinical evidence and differences in trial patient populations. Objective: To conduct a cost-effectiveness analysis comparing docetaxel with paclitaxel regimens in the treatment of MBC previously treated with an anthracycline from the perspective of the UK NHS. Methods: A cost-utility analysis was performed using a Markov model to compare taxanes in MBC patients who had progressed after treatment with an anthracycline-containing chemotherapy regimen: docetaxel 100 mg/$ m^{2} $ 1-hour intravenous (IV) infusion every 21 days versus paclitaxel 175 mg/$ m^{2} $ 3-hour IV infusion every 21 days (Pac3w). In parallel, additional analyses were performed versus paclitaxel administered in 1-weekly cycles (Pac1w), and a nano albumin-bound form of paclitaxel (Nab-P) given every 3 weeks. Progression-free survival (PFS), overall survival (OS) and adverse events used in the model were derived from a randomized trial directly comparing docetaxel with Pac3w; the comparisons of docetaxel versus the other two paclitaxel regimens were indirect, using patient-level data from a trial comparing Pac3w with Pac1w, and from the published literature comparing Pac3w with Nab-P. Utility values for response, progression and adverse events were derived from the literature. Direct treatment costs related to progression, best supportive care and adverse events were estimated using clinical trials data, published literature, NHS reference costs and published drug prices. The estimated costs of growth colony-stimulating factors and blood transfusion were also included in the model. The model was used to predict the expected total costs (£, year 2005–6 values), QALYs gained, incremental cost/life-year gained (LY) and cost/QALY over a 10-year time period. Results: In the base-case analysis, docetaxel improved QALYs by 0.33, 0.29 and 0.22 compared with Pac3w, Pac1w and Nab-P, respectively. The incremental cost-effectiveness ratios (ICERs) for docetaxel were £12 032/QALY versus Pac3w, £4583/QALY versus Pac1w and £14 694/QALY versus Nab-P. The ICER was sensitive to the hazard ratios for PFS and OS between the comparators, the drug cost of initial treatment and the treatment costs after progression. Taking into account parameter uncertainty, and comparing all four treatments simultaneously, at a willingness to pay of £20 000 per QALY gained, the probability of docetaxel being the most cost-effective treatment was around 70%. Conclusion: In the base-case scenario, docetaxel compared with Pac3w is estimated to have a cost-effectiveness ratio that falls within the acceptable threshold in the UK. The study also suggests that docetaxel may be cost effective versus Pac1w and Nab-P, although there is more uncertainty around these findings. | ||
650 | 4 | |a Overall Survival |7 (dpeaa)DE-He213 | |
650 | 4 | |a Paclitaxel |7 (dpeaa)DE-He213 | |
650 | 4 | |a Docetaxel |7 (dpeaa)DE-He213 | |
650 | 4 | |a Metastatic Breast Cancer |7 (dpeaa)DE-He213 | |
650 | 4 | |a Indirect Comparison |7 (dpeaa)DE-He213 | |
700 | 1 | |a Cameron, David A. |e verfasserin |4 aut | |
700 | 1 | |a Corson, Hélène |e verfasserin |4 aut | |
700 | 1 | |a Jones, Stephen E. |e verfasserin |4 aut | |
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10.2165/10899510-000000000-00000 doi (DE-627)SPR033340315 (SPR)10899510-000000000-00000-e DE-627 ger DE-627 rakwb eng 610 ASE 44.40 bkl Benedict, Ágnes verfasserin aut An Economic Evaluation of Docetaxel and Paclitaxel Regimens in Metastatic Breast Cancer in the UK 2009 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Background: Paclitaxel and docetaxel have been available for the treatment of metastatic breast cancer (MBC) since the 1990s. However, until very recently, comparisons between these two drugs have been difficult due to lack of direct comparative clinical evidence and differences in trial patient populations. Objective: To conduct a cost-effectiveness analysis comparing docetaxel with paclitaxel regimens in the treatment of MBC previously treated with an anthracycline from the perspective of the UK NHS. Methods: A cost-utility analysis was performed using a Markov model to compare taxanes in MBC patients who had progressed after treatment with an anthracycline-containing chemotherapy regimen: docetaxel 100 mg/$ m^{2} $ 1-hour intravenous (IV) infusion every 21 days versus paclitaxel 175 mg/$ m^{2} $ 3-hour IV infusion every 21 days (Pac3w). In parallel, additional analyses were performed versus paclitaxel administered in 1-weekly cycles (Pac1w), and a nano albumin-bound form of paclitaxel (Nab-P) given every 3 weeks. Progression-free survival (PFS), overall survival (OS) and adverse events used in the model were derived from a randomized trial directly comparing docetaxel with Pac3w; the comparisons of docetaxel versus the other two paclitaxel regimens were indirect, using patient-level data from a trial comparing Pac3w with Pac1w, and from the published literature comparing Pac3w with Nab-P. Utility values for response, progression and adverse events were derived from the literature. Direct treatment costs related to progression, best supportive care and adverse events were estimated using clinical trials data, published literature, NHS reference costs and published drug prices. The estimated costs of growth colony-stimulating factors and blood transfusion were also included in the model. The model was used to predict the expected total costs (£, year 2005–6 values), QALYs gained, incremental cost/life-year gained (LY) and cost/QALY over a 10-year time period. Results: In the base-case analysis, docetaxel improved QALYs by 0.33, 0.29 and 0.22 compared with Pac3w, Pac1w and Nab-P, respectively. The incremental cost-effectiveness ratios (ICERs) for docetaxel were £12 032/QALY versus Pac3w, £4583/QALY versus Pac1w and £14 694/QALY versus Nab-P. The ICER was sensitive to the hazard ratios for PFS and OS between the comparators, the drug cost of initial treatment and the treatment costs after progression. Taking into account parameter uncertainty, and comparing all four treatments simultaneously, at a willingness to pay of £20 000 per QALY gained, the probability of docetaxel being the most cost-effective treatment was around 70%. Conclusion: In the base-case scenario, docetaxel compared with Pac3w is estimated to have a cost-effectiveness ratio that falls within the acceptable threshold in the UK. The study also suggests that docetaxel may be cost effective versus Pac1w and Nab-P, although there is more uncertainty around these findings. Overall Survival (dpeaa)DE-He213 Paclitaxel (dpeaa)DE-He213 Docetaxel (dpeaa)DE-He213 Metastatic Breast Cancer (dpeaa)DE-He213 Indirect Comparison (dpeaa)DE-He213 Cameron, David A. verfasserin aut Corson, Hélène verfasserin aut Jones, Stephen E. verfasserin aut Enthalten in PharmacoEconomics Berlin [u.a.] : Springer, 1992 27(2009), 10 vom: Okt., Seite 847-859 (DE-627)327645717 (DE-600)2043876-X 1179-2027 nnns volume:27 year:2009 number:10 month:10 pages:847-859 https://dx.doi.org/10.2165/10899510-000000000-00000 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA SSG-OPC-PHA SSG-OPC-ASE GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_187 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_250 GBV_ILN_266 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_636 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2031 GBV_ILN_2034 GBV_ILN_2037 GBV_ILN_2038 GBV_ILN_2039 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2057 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2088 GBV_ILN_2093 GBV_ILN_2106 GBV_ILN_2107 GBV_ILN_2108 GBV_ILN_2110 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2113 GBV_ILN_2118 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2144 GBV_ILN_2147 GBV_ILN_2148 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2446 GBV_ILN_2470 GBV_ILN_2472 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_2548 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4336 GBV_ILN_4338 GBV_ILN_4393 GBV_ILN_4700 44.40 ASE AR 27 2009 10 10 847-859 |
spelling |
10.2165/10899510-000000000-00000 doi (DE-627)SPR033340315 (SPR)10899510-000000000-00000-e DE-627 ger DE-627 rakwb eng 610 ASE 44.40 bkl Benedict, Ágnes verfasserin aut An Economic Evaluation of Docetaxel and Paclitaxel Regimens in Metastatic Breast Cancer in the UK 2009 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Background: Paclitaxel and docetaxel have been available for the treatment of metastatic breast cancer (MBC) since the 1990s. However, until very recently, comparisons between these two drugs have been difficult due to lack of direct comparative clinical evidence and differences in trial patient populations. Objective: To conduct a cost-effectiveness analysis comparing docetaxel with paclitaxel regimens in the treatment of MBC previously treated with an anthracycline from the perspective of the UK NHS. Methods: A cost-utility analysis was performed using a Markov model to compare taxanes in MBC patients who had progressed after treatment with an anthracycline-containing chemotherapy regimen: docetaxel 100 mg/$ m^{2} $ 1-hour intravenous (IV) infusion every 21 days versus paclitaxel 175 mg/$ m^{2} $ 3-hour IV infusion every 21 days (Pac3w). In parallel, additional analyses were performed versus paclitaxel administered in 1-weekly cycles (Pac1w), and a nano albumin-bound form of paclitaxel (Nab-P) given every 3 weeks. Progression-free survival (PFS), overall survival (OS) and adverse events used in the model were derived from a randomized trial directly comparing docetaxel with Pac3w; the comparisons of docetaxel versus the other two paclitaxel regimens were indirect, using patient-level data from a trial comparing Pac3w with Pac1w, and from the published literature comparing Pac3w with Nab-P. Utility values for response, progression and adverse events were derived from the literature. Direct treatment costs related to progression, best supportive care and adverse events were estimated using clinical trials data, published literature, NHS reference costs and published drug prices. The estimated costs of growth colony-stimulating factors and blood transfusion were also included in the model. The model was used to predict the expected total costs (£, year 2005–6 values), QALYs gained, incremental cost/life-year gained (LY) and cost/QALY over a 10-year time period. Results: In the base-case analysis, docetaxel improved QALYs by 0.33, 0.29 and 0.22 compared with Pac3w, Pac1w and Nab-P, respectively. The incremental cost-effectiveness ratios (ICERs) for docetaxel were £12 032/QALY versus Pac3w, £4583/QALY versus Pac1w and £14 694/QALY versus Nab-P. The ICER was sensitive to the hazard ratios for PFS and OS between the comparators, the drug cost of initial treatment and the treatment costs after progression. Taking into account parameter uncertainty, and comparing all four treatments simultaneously, at a willingness to pay of £20 000 per QALY gained, the probability of docetaxel being the most cost-effective treatment was around 70%. Conclusion: In the base-case scenario, docetaxel compared with Pac3w is estimated to have a cost-effectiveness ratio that falls within the acceptable threshold in the UK. The study also suggests that docetaxel may be cost effective versus Pac1w and Nab-P, although there is more uncertainty around these findings. Overall Survival (dpeaa)DE-He213 Paclitaxel (dpeaa)DE-He213 Docetaxel (dpeaa)DE-He213 Metastatic Breast Cancer (dpeaa)DE-He213 Indirect Comparison (dpeaa)DE-He213 Cameron, David A. verfasserin aut Corson, Hélène verfasserin aut Jones, Stephen E. verfasserin aut Enthalten in PharmacoEconomics Berlin [u.a.] : Springer, 1992 27(2009), 10 vom: Okt., Seite 847-859 (DE-627)327645717 (DE-600)2043876-X 1179-2027 nnns volume:27 year:2009 number:10 month:10 pages:847-859 https://dx.doi.org/10.2165/10899510-000000000-00000 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA SSG-OPC-PHA SSG-OPC-ASE GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_187 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_250 GBV_ILN_266 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_636 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2031 GBV_ILN_2034 GBV_ILN_2037 GBV_ILN_2038 GBV_ILN_2039 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2057 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2088 GBV_ILN_2093 GBV_ILN_2106 GBV_ILN_2107 GBV_ILN_2108 GBV_ILN_2110 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2113 GBV_ILN_2118 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2144 GBV_ILN_2147 GBV_ILN_2148 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2446 GBV_ILN_2470 GBV_ILN_2472 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_2548 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4336 GBV_ILN_4338 GBV_ILN_4393 GBV_ILN_4700 44.40 ASE AR 27 2009 10 10 847-859 |
allfields_unstemmed |
10.2165/10899510-000000000-00000 doi (DE-627)SPR033340315 (SPR)10899510-000000000-00000-e DE-627 ger DE-627 rakwb eng 610 ASE 44.40 bkl Benedict, Ágnes verfasserin aut An Economic Evaluation of Docetaxel and Paclitaxel Regimens in Metastatic Breast Cancer in the UK 2009 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Background: Paclitaxel and docetaxel have been available for the treatment of metastatic breast cancer (MBC) since the 1990s. However, until very recently, comparisons between these two drugs have been difficult due to lack of direct comparative clinical evidence and differences in trial patient populations. Objective: To conduct a cost-effectiveness analysis comparing docetaxel with paclitaxel regimens in the treatment of MBC previously treated with an anthracycline from the perspective of the UK NHS. Methods: A cost-utility analysis was performed using a Markov model to compare taxanes in MBC patients who had progressed after treatment with an anthracycline-containing chemotherapy regimen: docetaxel 100 mg/$ m^{2} $ 1-hour intravenous (IV) infusion every 21 days versus paclitaxel 175 mg/$ m^{2} $ 3-hour IV infusion every 21 days (Pac3w). In parallel, additional analyses were performed versus paclitaxel administered in 1-weekly cycles (Pac1w), and a nano albumin-bound form of paclitaxel (Nab-P) given every 3 weeks. Progression-free survival (PFS), overall survival (OS) and adverse events used in the model were derived from a randomized trial directly comparing docetaxel with Pac3w; the comparisons of docetaxel versus the other two paclitaxel regimens were indirect, using patient-level data from a trial comparing Pac3w with Pac1w, and from the published literature comparing Pac3w with Nab-P. Utility values for response, progression and adverse events were derived from the literature. Direct treatment costs related to progression, best supportive care and adverse events were estimated using clinical trials data, published literature, NHS reference costs and published drug prices. The estimated costs of growth colony-stimulating factors and blood transfusion were also included in the model. The model was used to predict the expected total costs (£, year 2005–6 values), QALYs gained, incremental cost/life-year gained (LY) and cost/QALY over a 10-year time period. Results: In the base-case analysis, docetaxel improved QALYs by 0.33, 0.29 and 0.22 compared with Pac3w, Pac1w and Nab-P, respectively. The incremental cost-effectiveness ratios (ICERs) for docetaxel were £12 032/QALY versus Pac3w, £4583/QALY versus Pac1w and £14 694/QALY versus Nab-P. The ICER was sensitive to the hazard ratios for PFS and OS between the comparators, the drug cost of initial treatment and the treatment costs after progression. Taking into account parameter uncertainty, and comparing all four treatments simultaneously, at a willingness to pay of £20 000 per QALY gained, the probability of docetaxel being the most cost-effective treatment was around 70%. Conclusion: In the base-case scenario, docetaxel compared with Pac3w is estimated to have a cost-effectiveness ratio that falls within the acceptable threshold in the UK. The study also suggests that docetaxel may be cost effective versus Pac1w and Nab-P, although there is more uncertainty around these findings. Overall Survival (dpeaa)DE-He213 Paclitaxel (dpeaa)DE-He213 Docetaxel (dpeaa)DE-He213 Metastatic Breast Cancer (dpeaa)DE-He213 Indirect Comparison (dpeaa)DE-He213 Cameron, David A. verfasserin aut Corson, Hélène verfasserin aut Jones, Stephen E. verfasserin aut Enthalten in PharmacoEconomics Berlin [u.a.] : Springer, 1992 27(2009), 10 vom: Okt., Seite 847-859 (DE-627)327645717 (DE-600)2043876-X 1179-2027 nnns volume:27 year:2009 number:10 month:10 pages:847-859 https://dx.doi.org/10.2165/10899510-000000000-00000 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA SSG-OPC-PHA SSG-OPC-ASE GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_187 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_250 GBV_ILN_266 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_636 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2031 GBV_ILN_2034 GBV_ILN_2037 GBV_ILN_2038 GBV_ILN_2039 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2057 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2088 GBV_ILN_2093 GBV_ILN_2106 GBV_ILN_2107 GBV_ILN_2108 GBV_ILN_2110 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2113 GBV_ILN_2118 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2144 GBV_ILN_2147 GBV_ILN_2148 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2446 GBV_ILN_2470 GBV_ILN_2472 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_2548 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4336 GBV_ILN_4338 GBV_ILN_4393 GBV_ILN_4700 44.40 ASE AR 27 2009 10 10 847-859 |
allfieldsGer |
10.2165/10899510-000000000-00000 doi (DE-627)SPR033340315 (SPR)10899510-000000000-00000-e DE-627 ger DE-627 rakwb eng 610 ASE 44.40 bkl Benedict, Ágnes verfasserin aut An Economic Evaluation of Docetaxel and Paclitaxel Regimens in Metastatic Breast Cancer in the UK 2009 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Background: Paclitaxel and docetaxel have been available for the treatment of metastatic breast cancer (MBC) since the 1990s. However, until very recently, comparisons between these two drugs have been difficult due to lack of direct comparative clinical evidence and differences in trial patient populations. Objective: To conduct a cost-effectiveness analysis comparing docetaxel with paclitaxel regimens in the treatment of MBC previously treated with an anthracycline from the perspective of the UK NHS. Methods: A cost-utility analysis was performed using a Markov model to compare taxanes in MBC patients who had progressed after treatment with an anthracycline-containing chemotherapy regimen: docetaxel 100 mg/$ m^{2} $ 1-hour intravenous (IV) infusion every 21 days versus paclitaxel 175 mg/$ m^{2} $ 3-hour IV infusion every 21 days (Pac3w). In parallel, additional analyses were performed versus paclitaxel administered in 1-weekly cycles (Pac1w), and a nano albumin-bound form of paclitaxel (Nab-P) given every 3 weeks. Progression-free survival (PFS), overall survival (OS) and adverse events used in the model were derived from a randomized trial directly comparing docetaxel with Pac3w; the comparisons of docetaxel versus the other two paclitaxel regimens were indirect, using patient-level data from a trial comparing Pac3w with Pac1w, and from the published literature comparing Pac3w with Nab-P. Utility values for response, progression and adverse events were derived from the literature. Direct treatment costs related to progression, best supportive care and adverse events were estimated using clinical trials data, published literature, NHS reference costs and published drug prices. The estimated costs of growth colony-stimulating factors and blood transfusion were also included in the model. The model was used to predict the expected total costs (£, year 2005–6 values), QALYs gained, incremental cost/life-year gained (LY) and cost/QALY over a 10-year time period. Results: In the base-case analysis, docetaxel improved QALYs by 0.33, 0.29 and 0.22 compared with Pac3w, Pac1w and Nab-P, respectively. The incremental cost-effectiveness ratios (ICERs) for docetaxel were £12 032/QALY versus Pac3w, £4583/QALY versus Pac1w and £14 694/QALY versus Nab-P. The ICER was sensitive to the hazard ratios for PFS and OS between the comparators, the drug cost of initial treatment and the treatment costs after progression. Taking into account parameter uncertainty, and comparing all four treatments simultaneously, at a willingness to pay of £20 000 per QALY gained, the probability of docetaxel being the most cost-effective treatment was around 70%. Conclusion: In the base-case scenario, docetaxel compared with Pac3w is estimated to have a cost-effectiveness ratio that falls within the acceptable threshold in the UK. The study also suggests that docetaxel may be cost effective versus Pac1w and Nab-P, although there is more uncertainty around these findings. Overall Survival (dpeaa)DE-He213 Paclitaxel (dpeaa)DE-He213 Docetaxel (dpeaa)DE-He213 Metastatic Breast Cancer (dpeaa)DE-He213 Indirect Comparison (dpeaa)DE-He213 Cameron, David A. verfasserin aut Corson, Hélène verfasserin aut Jones, Stephen E. verfasserin aut Enthalten in PharmacoEconomics Berlin [u.a.] : Springer, 1992 27(2009), 10 vom: Okt., Seite 847-859 (DE-627)327645717 (DE-600)2043876-X 1179-2027 nnns volume:27 year:2009 number:10 month:10 pages:847-859 https://dx.doi.org/10.2165/10899510-000000000-00000 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA SSG-OPC-PHA SSG-OPC-ASE GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_187 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_250 GBV_ILN_266 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_636 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2031 GBV_ILN_2034 GBV_ILN_2037 GBV_ILN_2038 GBV_ILN_2039 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2057 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2088 GBV_ILN_2093 GBV_ILN_2106 GBV_ILN_2107 GBV_ILN_2108 GBV_ILN_2110 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2113 GBV_ILN_2118 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2144 GBV_ILN_2147 GBV_ILN_2148 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2446 GBV_ILN_2470 GBV_ILN_2472 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_2548 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4336 GBV_ILN_4338 GBV_ILN_4393 GBV_ILN_4700 44.40 ASE AR 27 2009 10 10 847-859 |
allfieldsSound |
10.2165/10899510-000000000-00000 doi (DE-627)SPR033340315 (SPR)10899510-000000000-00000-e DE-627 ger DE-627 rakwb eng 610 ASE 44.40 bkl Benedict, Ágnes verfasserin aut An Economic Evaluation of Docetaxel and Paclitaxel Regimens in Metastatic Breast Cancer in the UK 2009 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Background: Paclitaxel and docetaxel have been available for the treatment of metastatic breast cancer (MBC) since the 1990s. However, until very recently, comparisons between these two drugs have been difficult due to lack of direct comparative clinical evidence and differences in trial patient populations. Objective: To conduct a cost-effectiveness analysis comparing docetaxel with paclitaxel regimens in the treatment of MBC previously treated with an anthracycline from the perspective of the UK NHS. Methods: A cost-utility analysis was performed using a Markov model to compare taxanes in MBC patients who had progressed after treatment with an anthracycline-containing chemotherapy regimen: docetaxel 100 mg/$ m^{2} $ 1-hour intravenous (IV) infusion every 21 days versus paclitaxel 175 mg/$ m^{2} $ 3-hour IV infusion every 21 days (Pac3w). In parallel, additional analyses were performed versus paclitaxel administered in 1-weekly cycles (Pac1w), and a nano albumin-bound form of paclitaxel (Nab-P) given every 3 weeks. Progression-free survival (PFS), overall survival (OS) and adverse events used in the model were derived from a randomized trial directly comparing docetaxel with Pac3w; the comparisons of docetaxel versus the other two paclitaxel regimens were indirect, using patient-level data from a trial comparing Pac3w with Pac1w, and from the published literature comparing Pac3w with Nab-P. Utility values for response, progression and adverse events were derived from the literature. Direct treatment costs related to progression, best supportive care and adverse events were estimated using clinical trials data, published literature, NHS reference costs and published drug prices. The estimated costs of growth colony-stimulating factors and blood transfusion were also included in the model. The model was used to predict the expected total costs (£, year 2005–6 values), QALYs gained, incremental cost/life-year gained (LY) and cost/QALY over a 10-year time period. Results: In the base-case analysis, docetaxel improved QALYs by 0.33, 0.29 and 0.22 compared with Pac3w, Pac1w and Nab-P, respectively. The incremental cost-effectiveness ratios (ICERs) for docetaxel were £12 032/QALY versus Pac3w, £4583/QALY versus Pac1w and £14 694/QALY versus Nab-P. The ICER was sensitive to the hazard ratios for PFS and OS between the comparators, the drug cost of initial treatment and the treatment costs after progression. Taking into account parameter uncertainty, and comparing all four treatments simultaneously, at a willingness to pay of £20 000 per QALY gained, the probability of docetaxel being the most cost-effective treatment was around 70%. Conclusion: In the base-case scenario, docetaxel compared with Pac3w is estimated to have a cost-effectiveness ratio that falls within the acceptable threshold in the UK. The study also suggests that docetaxel may be cost effective versus Pac1w and Nab-P, although there is more uncertainty around these findings. Overall Survival (dpeaa)DE-He213 Paclitaxel (dpeaa)DE-He213 Docetaxel (dpeaa)DE-He213 Metastatic Breast Cancer (dpeaa)DE-He213 Indirect Comparison (dpeaa)DE-He213 Cameron, David A. verfasserin aut Corson, Hélène verfasserin aut Jones, Stephen E. verfasserin aut Enthalten in PharmacoEconomics Berlin [u.a.] : Springer, 1992 27(2009), 10 vom: Okt., Seite 847-859 (DE-627)327645717 (DE-600)2043876-X 1179-2027 nnns volume:27 year:2009 number:10 month:10 pages:847-859 https://dx.doi.org/10.2165/10899510-000000000-00000 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA SSG-OPC-PHA SSG-OPC-ASE GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_187 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_250 GBV_ILN_266 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_636 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2031 GBV_ILN_2034 GBV_ILN_2037 GBV_ILN_2038 GBV_ILN_2039 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2057 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2088 GBV_ILN_2093 GBV_ILN_2106 GBV_ILN_2107 GBV_ILN_2108 GBV_ILN_2110 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2113 GBV_ILN_2118 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2144 GBV_ILN_2147 GBV_ILN_2148 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2446 GBV_ILN_2470 GBV_ILN_2472 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_2548 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4336 GBV_ILN_4338 GBV_ILN_4393 GBV_ILN_4700 44.40 ASE AR 27 2009 10 10 847-859 |
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Enthalten in PharmacoEconomics 27(2009), 10 vom: Okt., Seite 847-859 volume:27 year:2009 number:10 month:10 pages:847-859 |
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Benedict, Ágnes @@aut@@ Cameron, David A. @@aut@@ Corson, Hélène @@aut@@ Jones, Stephen E. @@aut@@ |
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However, until very recently, comparisons between these two drugs have been difficult due to lack of direct comparative clinical evidence and differences in trial patient populations. Objective: To conduct a cost-effectiveness analysis comparing docetaxel with paclitaxel regimens in the treatment of MBC previously treated with an anthracycline from the perspective of the UK NHS. Methods: A cost-utility analysis was performed using a Markov model to compare taxanes in MBC patients who had progressed after treatment with an anthracycline-containing chemotherapy regimen: docetaxel 100 mg/$ m^{2} $ 1-hour intravenous (IV) infusion every 21 days versus paclitaxel 175 mg/$ m^{2} $ 3-hour IV infusion every 21 days (Pac3w). In parallel, additional analyses were performed versus paclitaxel administered in 1-weekly cycles (Pac1w), and a nano albumin-bound form of paclitaxel (Nab-P) given every 3 weeks. Progression-free survival (PFS), overall survival (OS) and adverse events used in the model were derived from a randomized trial directly comparing docetaxel with Pac3w; the comparisons of docetaxel versus the other two paclitaxel regimens were indirect, using patient-level data from a trial comparing Pac3w with Pac1w, and from the published literature comparing Pac3w with Nab-P. Utility values for response, progression and adverse events were derived from the literature. Direct treatment costs related to progression, best supportive care and adverse events were estimated using clinical trials data, published literature, NHS reference costs and published drug prices. The estimated costs of growth colony-stimulating factors and blood transfusion were also included in the model. The model was used to predict the expected total costs (£, year 2005–6 values), QALYs gained, incremental cost/life-year gained (LY) and cost/QALY over a 10-year time period. Results: In the base-case analysis, docetaxel improved QALYs by 0.33, 0.29 and 0.22 compared with Pac3w, Pac1w and Nab-P, respectively. The incremental cost-effectiveness ratios (ICERs) for docetaxel were £12 032/QALY versus Pac3w, £4583/QALY versus Pac1w and £14 694/QALY versus Nab-P. The ICER was sensitive to the hazard ratios for PFS and OS between the comparators, the drug cost of initial treatment and the treatment costs after progression. Taking into account parameter uncertainty, and comparing all four treatments simultaneously, at a willingness to pay of £20 000 per QALY gained, the probability of docetaxel being the most cost-effective treatment was around 70%. Conclusion: In the base-case scenario, docetaxel compared with Pac3w is estimated to have a cost-effectiveness ratio that falls within the acceptable threshold in the UK. 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610 ASE 44.40 bkl An Economic Evaluation of Docetaxel and Paclitaxel Regimens in Metastatic Breast Cancer in the UK Overall Survival (dpeaa)DE-He213 Paclitaxel (dpeaa)DE-He213 Docetaxel (dpeaa)DE-He213 Metastatic Breast Cancer (dpeaa)DE-He213 Indirect Comparison (dpeaa)DE-He213 |
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title_sort |
economic evaluation of docetaxel and paclitaxel regimens in metastatic breast cancer in the uk |
title_auth |
An Economic Evaluation of Docetaxel and Paclitaxel Regimens in Metastatic Breast Cancer in the UK |
abstract |
Abstract Background: Paclitaxel and docetaxel have been available for the treatment of metastatic breast cancer (MBC) since the 1990s. However, until very recently, comparisons between these two drugs have been difficult due to lack of direct comparative clinical evidence and differences in trial patient populations. Objective: To conduct a cost-effectiveness analysis comparing docetaxel with paclitaxel regimens in the treatment of MBC previously treated with an anthracycline from the perspective of the UK NHS. Methods: A cost-utility analysis was performed using a Markov model to compare taxanes in MBC patients who had progressed after treatment with an anthracycline-containing chemotherapy regimen: docetaxel 100 mg/$ m^{2} $ 1-hour intravenous (IV) infusion every 21 days versus paclitaxel 175 mg/$ m^{2} $ 3-hour IV infusion every 21 days (Pac3w). In parallel, additional analyses were performed versus paclitaxel administered in 1-weekly cycles (Pac1w), and a nano albumin-bound form of paclitaxel (Nab-P) given every 3 weeks. Progression-free survival (PFS), overall survival (OS) and adverse events used in the model were derived from a randomized trial directly comparing docetaxel with Pac3w; the comparisons of docetaxel versus the other two paclitaxel regimens were indirect, using patient-level data from a trial comparing Pac3w with Pac1w, and from the published literature comparing Pac3w with Nab-P. Utility values for response, progression and adverse events were derived from the literature. Direct treatment costs related to progression, best supportive care and adverse events were estimated using clinical trials data, published literature, NHS reference costs and published drug prices. The estimated costs of growth colony-stimulating factors and blood transfusion were also included in the model. The model was used to predict the expected total costs (£, year 2005–6 values), QALYs gained, incremental cost/life-year gained (LY) and cost/QALY over a 10-year time period. Results: In the base-case analysis, docetaxel improved QALYs by 0.33, 0.29 and 0.22 compared with Pac3w, Pac1w and Nab-P, respectively. The incremental cost-effectiveness ratios (ICERs) for docetaxel were £12 032/QALY versus Pac3w, £4583/QALY versus Pac1w and £14 694/QALY versus Nab-P. The ICER was sensitive to the hazard ratios for PFS and OS between the comparators, the drug cost of initial treatment and the treatment costs after progression. Taking into account parameter uncertainty, and comparing all four treatments simultaneously, at a willingness to pay of £20 000 per QALY gained, the probability of docetaxel being the most cost-effective treatment was around 70%. Conclusion: In the base-case scenario, docetaxel compared with Pac3w is estimated to have a cost-effectiveness ratio that falls within the acceptable threshold in the UK. The study also suggests that docetaxel may be cost effective versus Pac1w and Nab-P, although there is more uncertainty around these findings. |
abstractGer |
Abstract Background: Paclitaxel and docetaxel have been available for the treatment of metastatic breast cancer (MBC) since the 1990s. However, until very recently, comparisons between these two drugs have been difficult due to lack of direct comparative clinical evidence and differences in trial patient populations. Objective: To conduct a cost-effectiveness analysis comparing docetaxel with paclitaxel regimens in the treatment of MBC previously treated with an anthracycline from the perspective of the UK NHS. Methods: A cost-utility analysis was performed using a Markov model to compare taxanes in MBC patients who had progressed after treatment with an anthracycline-containing chemotherapy regimen: docetaxel 100 mg/$ m^{2} $ 1-hour intravenous (IV) infusion every 21 days versus paclitaxel 175 mg/$ m^{2} $ 3-hour IV infusion every 21 days (Pac3w). In parallel, additional analyses were performed versus paclitaxel administered in 1-weekly cycles (Pac1w), and a nano albumin-bound form of paclitaxel (Nab-P) given every 3 weeks. Progression-free survival (PFS), overall survival (OS) and adverse events used in the model were derived from a randomized trial directly comparing docetaxel with Pac3w; the comparisons of docetaxel versus the other two paclitaxel regimens were indirect, using patient-level data from a trial comparing Pac3w with Pac1w, and from the published literature comparing Pac3w with Nab-P. Utility values for response, progression and adverse events were derived from the literature. Direct treatment costs related to progression, best supportive care and adverse events were estimated using clinical trials data, published literature, NHS reference costs and published drug prices. The estimated costs of growth colony-stimulating factors and blood transfusion were also included in the model. The model was used to predict the expected total costs (£, year 2005–6 values), QALYs gained, incremental cost/life-year gained (LY) and cost/QALY over a 10-year time period. Results: In the base-case analysis, docetaxel improved QALYs by 0.33, 0.29 and 0.22 compared with Pac3w, Pac1w and Nab-P, respectively. The incremental cost-effectiveness ratios (ICERs) for docetaxel were £12 032/QALY versus Pac3w, £4583/QALY versus Pac1w and £14 694/QALY versus Nab-P. The ICER was sensitive to the hazard ratios for PFS and OS between the comparators, the drug cost of initial treatment and the treatment costs after progression. Taking into account parameter uncertainty, and comparing all four treatments simultaneously, at a willingness to pay of £20 000 per QALY gained, the probability of docetaxel being the most cost-effective treatment was around 70%. Conclusion: In the base-case scenario, docetaxel compared with Pac3w is estimated to have a cost-effectiveness ratio that falls within the acceptable threshold in the UK. The study also suggests that docetaxel may be cost effective versus Pac1w and Nab-P, although there is more uncertainty around these findings. |
abstract_unstemmed |
Abstract Background: Paclitaxel and docetaxel have been available for the treatment of metastatic breast cancer (MBC) since the 1990s. However, until very recently, comparisons between these two drugs have been difficult due to lack of direct comparative clinical evidence and differences in trial patient populations. Objective: To conduct a cost-effectiveness analysis comparing docetaxel with paclitaxel regimens in the treatment of MBC previously treated with an anthracycline from the perspective of the UK NHS. Methods: A cost-utility analysis was performed using a Markov model to compare taxanes in MBC patients who had progressed after treatment with an anthracycline-containing chemotherapy regimen: docetaxel 100 mg/$ m^{2} $ 1-hour intravenous (IV) infusion every 21 days versus paclitaxel 175 mg/$ m^{2} $ 3-hour IV infusion every 21 days (Pac3w). In parallel, additional analyses were performed versus paclitaxel administered in 1-weekly cycles (Pac1w), and a nano albumin-bound form of paclitaxel (Nab-P) given every 3 weeks. Progression-free survival (PFS), overall survival (OS) and adverse events used in the model were derived from a randomized trial directly comparing docetaxel with Pac3w; the comparisons of docetaxel versus the other two paclitaxel regimens were indirect, using patient-level data from a trial comparing Pac3w with Pac1w, and from the published literature comparing Pac3w with Nab-P. Utility values for response, progression and adverse events were derived from the literature. Direct treatment costs related to progression, best supportive care and adverse events were estimated using clinical trials data, published literature, NHS reference costs and published drug prices. The estimated costs of growth colony-stimulating factors and blood transfusion were also included in the model. The model was used to predict the expected total costs (£, year 2005–6 values), QALYs gained, incremental cost/life-year gained (LY) and cost/QALY over a 10-year time period. Results: In the base-case analysis, docetaxel improved QALYs by 0.33, 0.29 and 0.22 compared with Pac3w, Pac1w and Nab-P, respectively. The incremental cost-effectiveness ratios (ICERs) for docetaxel were £12 032/QALY versus Pac3w, £4583/QALY versus Pac1w and £14 694/QALY versus Nab-P. The ICER was sensitive to the hazard ratios for PFS and OS between the comparators, the drug cost of initial treatment and the treatment costs after progression. Taking into account parameter uncertainty, and comparing all four treatments simultaneously, at a willingness to pay of £20 000 per QALY gained, the probability of docetaxel being the most cost-effective treatment was around 70%. Conclusion: In the base-case scenario, docetaxel compared with Pac3w is estimated to have a cost-effectiveness ratio that falls within the acceptable threshold in the UK. The study also suggests that docetaxel may be cost effective versus Pac1w and Nab-P, although there is more uncertainty around these findings. |
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container_issue |
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title_short |
An Economic Evaluation of Docetaxel and Paclitaxel Regimens in Metastatic Breast Cancer in the UK |
url |
https://dx.doi.org/10.2165/10899510-000000000-00000 |
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Cameron, David A. Corson, Hélène Jones, Stephen E. |
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doi_str |
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up_date |
2024-07-03T18:03:33.846Z |
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score |
7.399292 |