Capecitabine plus docetaxel combination therapy

Cost-effectiveness in patients with anthracycline-pretreated advanced breast carcinoma

Authors

  • Shailendra Verma M.D.,

    Corresponding author
    1. Department of Medical Oncology, Ottawa Regional Cancer Centre, Ottawa, Canada
    • Ottawa Regional Cancer Centre (Centre Régional de Cancérologie d'Ottawa), 503 Smyth Road, Ottawa, Ontario, K1H 1CY, Canada
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    • Fax: (613) 247-3511

  • Dominique Maraninchi M.D.,

    1. Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
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  • Joyce O'Shaughnessy M.D.,

    1. Baylor-Sammons Cancer Center, Dallas, Texas
    2. US Oncology Research, Houston, Texas
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    • Dr. O'Shaughnessy is a member of the Speakers' Bureau for Roche and Aventis.

  • Carol Jamieson,

    1. Hoffmann-La Roche, Palo Alto, California
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    • Carol Jamieson is an employee of Johnson & Johnson Pharmaceuticals.

  • Stephen Jones M.D.,

    1. Baylor-Sammons Cancer Center, Dallas, Texas
    2. US Oncology Research, Houston, Texas
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  • Miguel Martín M.D.,

    1. Department of Medical Oncology, Hospital Universitario San Carlos, Madrid, Spain
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  • Joseph McKendrick M.D.,

    1. Department of Oncology, Box Hill Hospital, Melbourne, Australia
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  • David Miles M.D.,

    1. ICRF Breast Cancer Biology Unit, Guy's and St Thomas' Hospital, London, England
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  • Chris Twelves M.D.,

    1. Department of Medical Oncology, Beatson Oncology Centre, Glasgow, Scotland
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    • Dr. Twelves has acted as an ad hoc consultant to Roche and has also received honoraria for speaking and served on advisory committees for Roche.

  • John Hornberger M.D.

    1. Department of Clinical Economics, The SPHERE Institute/Acumen, LLC, Burlingame, California
    2. Department of Medicine, Department of Veteran Affairs, Palo Alto, California
    3. Department of Medicine, Stanford University School of Medicine, Stanford, California
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    • Dr. Hornberger has a consulting arrangement with federal agencies (Veterans Administration, U.S. Health Resources and Services Administration, National Institutes of Health) and with private companies (Roche, Allergan, Boston Scientific, Amgen, and Genomic Health).


  • F. Hoffmann-La Roche Ltd. supported the development of the model and the subsequent analyses. The sponsor had no role in the model design, cost-effectiveness analysis, or interpretation of the results. All investigators had unlimited access to the model and data. No limitations on publication were imposed. The authors made the final decisions on all aspects of the current article.

Abstract

BACKGROUND

For patients with anthracycline-pretreated metastatic breast carcinoma, capecitabine plus docetaxel significantly increased overall survival compared with docetaxel alone. The current study evaluated the cost-effectiveness of the capecitabine/docetaxel combination versus docetaxel monotherapy, comparing the gain in quality-adjusted survival with associated health care costs.

METHODS

Patients were randomized to receive 21-day cycles of oral capecitabine 1250 mg/m2 twice daily, on Days 1–14, plus docetaxel 75 mg/m2 Day 1 (n = 255), or docetaxel 100 mg/m2 on Day 1 (n = 256). Health and cost outcomes in the two arms were compared, and cost-effectiveness was estimated. Data on survival time and medical care resource use were prospectively collected in the trial. Costs associated with medical care resource use and quality-of-life adjustments were obtained from the published literature. The incremental cost-effectiveness ratio was calculated as the cost per quality-adjusted life year (QALY) gained.

RESULTS

Capecitabine/docetaxel increased the median overall survival by 3 months compared with docetaxel alone (14.5 vs. 11.5 months). The mean quality-adjusted survival was increased by 1.8 months in the capecitabine/docetaxel group. The total medical-resource utilization cost per patient was 8.9% higher with the combination: $24,475 for combination therapy versus $22,477 for single-agent docetaxel. The mean cost per QALY gained with combination therapy was $13,558 (standard deviation, $6742). Cost savings due to reduced docetaxel dose and hospital use were the major cost offsets with the combination. Sensitivity analyses showed that varying the mean hospital cost per day from the 5th to the 95th percentile resulted in cost-utility ratios ranging from $20,326 to as low as $6360.

CONCLUSIONS

Capecitabine/docetaxel was a cost-effective treatment in patients with anthracycline-pretreated advanced breast carcinoma, and had an incremental cost-effectiveness ratio that compares very favorably with that of many other oncology therapies. Cancer 2005. © 2005 American Cancer Society.

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