Cost-effectiveness of paclitaxel, doxorubicin, cyclophosphamide and trastuzumab versus docetaxel, cisplatin and trastuzumab in new adjuvant therapy of breast cancer in china

Cost Effectiveness and Resource Allocation

Li Yuanyuan¹  Qiaoping Xu²  Li Qingyu²  Liu Jian²  Shi Changchen²  Zhu Jiejing²  Li Yangling²  Yan Wei²  Luo Ying³  Chen Lingya⁴ 

[1] Center for Healthcare Security Dig Data and Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Road, 310058, Hangzhou, Zhejiang, China;Department of Pharmacy, Hangzhou First People’s Hospital, School of Medicine, Zhejiang University, 310006, Hangzhou, China;Hangzhou Senile Hospital, 310022, Hangzhou, Zhejiang, China;Zhejiang Cancer Hospital, 310022, Hangzhou, Zhejiang, China;

关键词: Breast cancer;    Neoadjuvant chemotherapy;    Pharmaceutical economics;    Markov model;    Cost-effectiveness analysis;   

DOI  :  10.1186/s12962-021-00264-w

来源: Springer

【 摘 要 】

BackgroundBreast cancer is the most common cancer among women in China. Amplification of the Human epidermal growth factor receptor type 2 (HER2) gene is present and overexpressed in 18–20% of breast cancers and historically has been associated with inferior disease-related outcomes. There has been increasing interest in de-escalation of therapy for low-risk disease. This study analyzes the cost-effectiveness of Doxorubicin/ Cyclophosphamide/ Paclitaxel/ Trastuzumab (AC-TH) and Docetaxel/Carboplatin/Trastuzumab(TCH) from payer perspective over a 5 year time horizon.MethodsA half-cycle corrected Markov model was built to simulate the process of breast cancer events and death occurred in both AC-TH and TCH armed patients. Cost data came from studies based on a Chinese hospital. One-way sensitivity analyses as well as second-order Monte Carlo and probabilistic sensitivity analyses were performed.The transition probabilities and utilities were extracted from published literature, and deterministic sensitivity analyses were conducted.ResultsWe identified 41 breast cancer patients at Hangzhou First People’s Hospital, among whom 15 (60%) had a partial response for AC-TH treatment and 13 (81.25%) had a partial response for TCH treatment.No cardiac toxicity was observed. Hematologic grade 3 or 4 toxicities were observed in 1 of 28 patients.Nonhematologic grade 3 or 4 toxicities with a reverse pattern were observed in 6 of 29 patients. The mean QALY gain per patient compared with TCH was 0.25 with AC-TH, while the incremental costs were $US13,142. The incremental cost-effectiveness ratio (ICER) of AC-TH versus TCH was $US 52,565 per QALY gained.ConclusionsThis study concluded that TCH neoadjuvant chemotherapy was feasible and active in HER2-overexpressing breast cancer patients in terms of the pathological complete response, complete response, and partial response rates and manageable toxicities.

【 授权许可】

CC BY