Cost-Effectiveness Analysis of Adjuvant Therapy for Operable Breast Cancer from a Chinese Perspective

Abstract

An oncology trial compared four cycles of doxorubicin/cyclophosphamide (AC) with four cycles of docetaxel/cyclophosphamide (TC) in operable breast cancer patients (71% were diagnosed with hormone receptor positive and 48% with node-negative breast cancer). The objective of this study was to estimate the lifetime cost effectiveness of AC versus TC, from a Chinese healthcare provider perspective, based on a clinical trial. A lifetime cost-effectiveness analysis was performed using a Markov model. Events rates and utilities in the Markov model were derived from published papers. Data on cost of breast cancer care were obtained from the Second Xiangya Hospital of Central South University, Changsha, PR China. One-way sensitivity analysis and probabilistic sensitivity analysis were undertaken. Cost estimates were valued in Chinese yuan (Y), year 2008 values. All costs and outcomes were discounted at 3% per annum. Patients receiving TC gained 14.45 QALYs, 0.41 QALYs more than patients receiving AC. The lifetime costs of patients receiving TC were Y93 511, Y10 116 more than that of AC patients. The incremental cost-effectiveness ratios were Y26 742 per life-year gained ( pound 2719.8 per year) and Y24 305 per QALY gained ( pound2471.9 per QALY). The most sensitive parameter in the model was the cost of primary cancer treatments in the TC arm. At a threshold willingness to pay of Y86 514 per QALY, the probability of TC being cost effective was 90%. Our model suggests that TC may be considered cost effective from a Chinese healthcare provider perspective, according to the threshold defined by the WHO.

The Cost–Utility of Adjuvant Chemotherapy Using Docetaxel and Cyclophosphamide Compared with Doxorubicin and Cyclophosphamide in Breast Cancer

“…In our evaluation, tc was associated with higher estimated upfront costs relative to ac ($6,597 vs. $1,298), with an incremental cost difference of $5,299 per patient, primarily reflecting higher drug acquisition costs ($5,850 vs. $269). Should docetaxel become generic, lower upfront tc costs would result in an even more favorable cost-utility estimate, as observed in our study and the study by Liubao et al 41 . The cost-utility estimate of tc relative to ac is also affected by the horizon examined (that is, the analysis timeframe).…”

“…As with all economic analyses, the results may not be generalizable to all other health care jurisdictions because of variation in upfront or downstream costs (or both) for chemotherapeutic drugs and cancer management. However, the very favorable cost-utility estimates observed in our study and in the study by Liubao et al 41 from the perspectives of the Canadian and the Chinese health care systems respectively, make it unlikely that tc would not be a cost-effective strategy in other jurisdictions. To test the robustness of our model, we performed mainly one-way sensitivity analyses (as opposed to probabilistic sensitivity analyses) because of a lack of evidence-based probability distributions for many of the parameters and because of the difficulties arising from defining arbitrary distributions [9][10][11] .…”

“…As in our study, their results were sensitive to the horizon examined, with a cost-utility of $43,248 per qaly gained at a 7-year horizon. In a recent publication from a Chinese perspective, Liubao et al 41 reported an incremental gain of 0.41 qalys and 10,116 Chinese yuan (approximately CA$1,547) in higher costs associated with tc relative to ac at a lifetime horizon (40 years), with an incremental costeffectiveness ratio of 24,305 yuan (approximately CA$3,716) per qaly gained. At a willingness-to-pay threshold of 86,514 yuan (approximately CA$13,173) per qaly, the probability of tc being cost-effective was 90%.…”

Cost-Utility of "Doxorubicin and Cyclophosphamide" versus "Gemcitabine and Paclitaxel" for Treatment of Patients with Breast Cancer in Iran

“…They showed that the high cost of the PG regimen was due to the costs of chemotherapy drugs in PG regimen and the Gemcitabin on the eighth day (Chen et al, 2002). Bernard et al in 2011, Younis et al in 2011 and Liubao in separate studies showed that the low cost of the AC regimen was due to the costs of chemotherapy drugs in AC regimen (Liubao et al, 2009;Bernard et al, 2011;Younis et al, 2011).…”

Economic Evaluation of First-Line Adjuvant Chemotherapies for Resectable Gastric Cancer Patients in China

“…Costs estimated for managing nausea and vomiting, and laboratory evaluations were from the report by Liubao Peng [24], in which an economic evaluation of adjuvant therapy for operable breast cancer was performed under the Chinese healthcare perspective. The cost of oxaliplatin per 50 mg and S-1 per 20 mg were estimated using the prices of different brands and the prevalence of the use of each brand in China [17,26].…”