The clinical effectiveness and cost-effectiveness of gemcitabine for metastatic breast cancer: a systematic review and economic evaluation

Abstract

The review of clinical effectiveness is based on data from a single RCT that has not yet been fully published. While only tentative conclusions can be drawn from this, the evidence may indicate that treatment with gemcitabine and paclitaxel confers an improved outcome for patients in terms of survival and disease progression, but at the cost of increased toxicity. An economic model developed for this review reflects high costs per QALY for this treatment combination. The base-case analysis shows high ICERs, with costs per QALY gained close to 60,000 pounds. Adopting a more realistic treatment protocol, with chemotherapy limited to a maximum of six cycles, gives a more favourable cost-effectiveness estimate. However, this was still higher than would usually be considered to be a cost-effective treatment from the NHS's perspective. Future research recommendations include an update of this review in 12-18 months' time, by which time the included RCT should be fully published. It would also be useful to compare gemcitabine with currently used treatments for metastatic breast cancer, including capecitabine and vinorelbine.

Medical Care Costs for Recurrent versus De Novo Stage IV Cancer by Age at Diagnosis

“…In addition, many cost‐effectiveness analyses associated with treatment trials for patients with metastatic cancer fail to differentiate between de novo versus recurrent metastatic cancer postdiagnosis cost trajectories (Takeda et al. ; Lange et al. ).…”

Cost-Effectiveness Analysis of Neoadjuvant Chemotherapy with Intensive Dose of Epirubicin and Different Cycles in Patients with Locally Advanced Breast Cancer: 4 Fe100c Vs. 6 Fe100 C

“…Study results have robustness according to the univariate sensitivity analysis and despite the cost increase with 6 FE 100 C, this therapeutic method continues to be a more economical option in spite of the introduction of new therapies, such as taxanes, gemcitabine and capecitabine [47][48][49][50]. Results obtained show the fact that the use of regimen with 6 FE 100 C is the therapeutic alternative that allows achieving a benefit in the effectiveness despite having a higher cost; the ICER establishes a necessary cost of $11,765,925.42 MXN (€905,071.20) for each additional case being successfully treated assuming 6 FE 100 C against 4 FE 100 C, this would allow performing a greater percentage of surgeries with healing character; if we dealt with patients with metastatic breast cancer, an ICER analysis would be much more elevated due to the fact that differences in effectiveness are smaller.…”

Pharmacoeconomic considerations in the treatment of breast cancer

“…[94][95][96] A Markov model was developed to estimate the cost-effectiveness of gemcitabine-paclitaxel in patients with MBC and reported an incremental cost-effectiveness ratio (ICER) of £38,699 per QALY gained, which is higher than the threshold defined by the NHS. 97 Despite the high incidence of breast cancer and the great amount of data in the field of first-line therapy, limited economic evidence is available about the cost-effectiveness of the various treatment options presented. An economic evaluation for first-line sequential therapy was reported by the National Institute for Health and Clinical Excellence (NICE).…”