Taxanes for the adjuvant treatment early breast cancer: systematic review and economic evaluation
Ward S, Simpson E, Davis S, Hind D, Rees A, Wilkinson A
Record ID 32007000627
The objectives were to estimate the clinical effectiveness and cost-effectiveness of docetaxel and paclitaxel compared with non-taxane, anthracycline-containing chemotherapy regimens, for the adjuvant treatment of women with early-stage breast cancer.
There is a large degree of heterogeneity in the evidence base for the effectiveness of taxane- compared with non-taxane-containing regimens in terms of the interventions, comparators and populations. Eight of the 11 trials providing effectiveness data reported a significant improvement in DFS or TTR for taxanes over comparator regimens. The remaining three trials found no significant differences between the groups in DFS/TTR. However, there were few data available comparing licensed regimens of taxanes with chemotherapy regimens commonly used in the UK.
The cost-effectiveness results suggest that docetaxel-containing chemotherapy has a cost per QALY of 12,000 (7000;39,000) compared with non-taxane-containing chemotherapy based on the regimen used in the BCRIG 001 study, whereas paclitaxel-containing chemotherapy has a cost per QALY of 43,000 (16,000;dominated) compared with non-taxane-containing chemotherapy based on the regimens used in the NSABP B28 study and a cost per QALY of 39,000 (12,000;dominated) based on the regimens used in the CALGB 9344 study. However, the comparators in these trials do not reflect the regimens currently used in the UK. The use of indirect comparison demonstrates that there is a high degree of uncertainty in the effectiveness of taxane-containing regimens relative to regimens in common use in the UK and therefore the cost-effectiveness of taxanes compared with current standard practice is considered to be unproven at this time. The cost-effectiveness of taxanes will need to be reconsidered as further data become available from ongoing trials comparing taxanes with standard UK regimens. Of particular interest will be the TACT trial, which compares four cycles of FEC followed by four cycles of docetaxel with two regimens used in the UK ; eight cycles of FEC or four cycles of EMF, followed by four cycles of CMF. This trial is expected to report efficacy data in the next year or two.(all costs in UKP)
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England, United Kingdom
- Antineoplastic Combined Chemotherapy Protocols
- Breast Neoplasms
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