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Cost-Effectiveness Analysis of Docetaxel Versus Weekly Paclitaxel in Adjuvant Treatment of Regional Breast Cancer in New Zealand

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Abstract

Background

There have been recent important changes to adjuvant regimens and costs of taxanes for the treatment of early breast cancer, requiring a re-evaluation of comparative cost effectiveness. In particular, weekly paclitaxel is now commonly used but has not been subjected to cost-effectiveness analysis.

Aim

Our aim was to estimate the cost effectiveness of adjuvant docetaxel and weekly paclitaxel versus each other, and compared with standard 3-weekly paclitaxel, in women aged ≥25 years diagnosed with regional breast cancer in New Zealand.

Methods

A macrosimulation Markov model was used, with a lifetime horizon and health system perspective. The model compared 3-weekly docetaxel and weekly paclitaxel versus standard 3-weekly paclitaxel (E1199 regimen) in the hospital setting. Data on overall survival and toxicities (febrile neutropenia and peripheral neuropathy) were derived from relevant published clinical trials. Epidemiological and cost data were derived from New Zealand datasets. Health outcomes were measured with health-adjusted life-years (HALYs), similar to quality-adjusted life-years (QALYs). Costs included intervention and health system costs in year 2011 values, with 3 % per annum discounting on costs and HALYs.

Results

The mean HALY gain per patient compared with standard 3-weekly paclitaxel was 0.51 with weekly paclitaxel and 0.21 with docetaxel, while incremental costs were $NZ12,284 and $NZ4,021, respectively. The incremental cost-effectiveness ratio (ICER) of docetaxel versus 3-weekly paclitaxel was $NZ19,400 (purchasing power parity [PPP]-adjusted $US13,100) per HALY gained, and the ICER of weekly paclitaxel versus docetaxel was $NZ27,100 ($US18,300) per HALY gained. In terms of net monetary benefit, weekly paclitaxel was the optimal strategy for willingness-to-pay (WTP) thresholds >$NZ27,000 per HALY gained. However, the model was highly sensitive to uncertainty around survival differences, while toxicity-related morbidity had little impact. Thus, if it was assumed that weekly paclitaxel and docetaxel had the same efficacy, docetaxel would be favoured over weekly paclitaxel.

Conclusion

Both weekly paclitaxel and docetaxel are likely to be cost effective compared with standard 3-weekly paclitaxel. Weekly paclitaxel was the optimal choice for WTP thresholds greater than $NZ27,000 per HALY gained (PPP-adjusted $US18,000). However, uncertainty remains around relative survival benefits, and weekly paclitaxel becomes cost ineffective versus docetaxel if it is assumed that the two regimens have equal effectiveness. Reduced uncertainty about the relative survival benefits may improve decision making for funding.

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Notes

  1. The UK National Institute for Health and Care Excellence (NICE) recommends adjuvant treatment with docetaxel rather than paclitaxel in node-positive breast cancer. However, this is because there is a lack of evidence for the use of paclitaxel in combination with the standard chemotherapy regimens used in the UK, rather than because of a clinical advantage per se [8].

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Acknowledgments

The authors thank Dr Andrew Simpson (Capital & Coast District Health Board) and other BODE3 team colleagues for comments on early versions of this work.

R Webber-Foster, T Blakely and G Kvizhinadze contributed to the conceptualization and design of the model. T Blakely and G Kvizhinadze contributed to epidemiological inputs to the model. R Webber-Foster and G Rivalland contributed to parameterization of clinical inputs and costs. G Kvizhinadze carried out the modelling. R Webber-Foster wrote the manuscript, with review and revision by all authors.

Funding

The BODE3 programme receives funding support from the Health Research Council of New Zealand (10/248).

Competing interests

The authors have no competing interests.

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Authors and Affiliations

  1. Burden of Disease Epidemiology, Equity and Cost-Effectiveness (BODE3) Programme, University of Otago-Wellington, PO Box 7343, 23 Mein Street, Newtown, Wellington, New Zealand

    Rachel Webber-Foster, Giorgi Kvizhinadze & Tony Blakely

  2. Department of Oncology, Auckland City Hospital, Park Road, Grafton, Auckland, New Zealand

    Gareth Rivalland

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  1. Rachel Webber-Foster
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  2. Giorgi Kvizhinadze
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  4. Tony Blakely
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Correspondence to Tony Blakely.

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Webber-Foster, R., Kvizhinadze, G., Rivalland, G. et al. Cost-Effectiveness Analysis of Docetaxel Versus Weekly Paclitaxel in Adjuvant Treatment of Regional Breast Cancer in New Zealand. PharmacoEconomics 32, 707–724 (2014). https://doi.org/10.1007/s40273-014-0154-x

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