Inpharma 1320 - 12 Jan 2002

Cancer news from the 4th Annual ISPOR MeetingCannes, France November 2001

Pharmacoeconomic analyses of treatments for docetaxel and paclitaxel.various cancers were the subject of numerous Only direct health costs were considered, and werepresentations at the 4th Annual Meeting of the calculated from the perspective of hospitals in theInternational Society for Pharmacoeconomics and Spanish National Health System. Costs were thoseOutcomes Research (ISPOR) [Cannes, France; related to drug acquisition, premedication, supportNovember 2001]. The following report highlights a treatment, IV hydration and diluents, hospital stay,selection of these analyses. nursing/medical staff time, laboratory tests and

Using clinical evidence from a pivotal randomised monitoring and toxicity.trial, a UK-based investigative team compared docetaxel Choose first-line anastrozole in breastmonotherapy with best supportive care as second-line cancertherapy in patients with advanced non-small-cell lung

In postmenopausal women with advanced breastcancer (NSCLC) and found that, based on currentcancer positive for estrogen or progesterone receptors,practice in the UK, docetaxel is cost effective in patientsthe aromatase inhibitor anastrozole has been shown topreviously treated with platinum-based chemotherapybe cost effective from an Italian healthcare systemin whom relapse has occurred.1

perspective, compared with tamoxifen, despite its muchDocetaxel worth the cost in NSCLC higher acquisition cost.

The analysis compared the use of docetaxel 75 mg/m2 Investigators from Italy used a Markov model toplus best supportive care versus best supportive care determine the direct costs and outcomes associatedalone over a 2-year period. For the purpose of the with tamoxifen 20 mg/day compared with anastrozole 1analysis, a 3.82-month survival advantage for docetaxel mg/day as first-line therapy administered toover best supportive care was calculated from the area postmenopausal women with advanced breast cancer,under each survival curve (8.98 vs 5.16 months). The for an overall study duration of 80 months.3 The medianinvestigators revealed that treatment with docetaxel cost time to disease progression stood at 6 months for thosean estimated £13 618 per life-year gained (LYG) over the who received tamoxifen and nearly 10 months for thosestudy period, compared with best supportive care. The who received anastrozole.cost-effectiveness ratio ranged from £7086 to £28 905 Monthly estimates revealed that, althoughper LYG over best- and worse-case scenarios, anastrozole recipients had a shorter duration of disease-respectively. Sensitivity analysis suggested that the free survival than tamoxifen recipients (8.1 vs 11.2factor exerting the most influence over the cost per LYG months), both median survival and median quality-was the cost of docetaxel itself. adjusted life-expectancy were longer in patients who

were treated with anastrozole, compared withA NICE resulttamoxifen (39.5 vs 36.8 and 19.4 vs 17.4 months,The investigators note that the results of their cost- respectively). Taking into account the higher per-patienteffectiveness analysis were taken into account by the UK costs associated with anastrozole ($US15 112 vs $US13National Institute for Clinical Excellence (NICE) in its 401), the cost per progression-free month associatedguidance issued last year recommending docetaxel (and with anastrozole therapy was an estimated $US1204,3 other chemotherapy drugs) in this setting.* and the cost per quality-adjusted life-year (QALY) gainedCosts considered in the analysis were discounted at was about $US10 500, relative to treatment with6% per annum and were driven for the most part by drug tamoxifen.acquisition and administration, note the investigators. Only direct costs were considered, including those

Docetaxel-based first-line therapy cost related to drug acquisition, thromboembolic events andsaving cancer care. At less than $US20 000 per QALY gained,

anastrozole is a cost-effective option in women withThe Eastern Cooperative Oncology Group (ECOG)advanced breast cancer, comment the investigators.1594 trial was used as the basis of a cost-minimisation

analysis carried out by researchers from the US and First year of breast cancer therapy nearlySpain. It was found that, among 1207 patients with stage 75% of total costIII or IV NSCLC, first-line treatment with docetaxel plus Researchers from France conducted a retrospectivecisplatin led to cost savings when compared with both analysis of the total medical cost associated with breastpaclitaxel plus cisplatin and paclitaxel plus carboplatin.2 cancer, from the time of diagnosis of the diseaseOver the course of the ECOG 1594 study, there were through to follow-up, in patients treated at ano significant differences across treatment groups in comprehensive cancer centre in France.4 They foundmedian survival time, survival at 1 year, median time to that, over the observation period January 1995 todisease progression, or complete or partial response to February 2000, approximately 73% of the total costtreatment [see table 1]. However, average per-patient could be attributed to the initial diagnosis stage and thetreatment costs associated with docetaxel plus cisplatin first year of treatment.were considerably lower than with the other two first- The researchers evaluated the medical records of 120line treatment options; the costs associated with patients with breast cancer treated for the first time atdocetaxel plus cisplatin were 1788 and 2105 euros the Centre Rene Huguenin, France. Following diagnosis,lower when compared with paclitaxel plus cisplatin and all 120 women underwent surgery; in addition, womenpaclitaxel plus carboplatin, respectively. The researchers were treated with radiotherapy or chemotherapy. Thenote that the difference in costs between docetaxel plus mean per-patient cost of therapy in the initial treatmentcisplatin and the other two comparators was due stage was an estimated 7378 euros. In contrast, theprimarily to the acquisition cost differential between mean per-patient cost of follow-up over the study period

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Inpharma 12 Jan 2002 No. 13201173-8324/10/1320-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

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was about 791 euros, representing just under 8% of the Table. Outcomes and costs associated with first-total medical cost. However, this cost rose considerably line therapy for NSCLCwhen the management of noncarcinogenic events (e.g.Docetaxel Paclitaxel Paclitaxelreconstructive surgery) and carcinogenic events (e.g.+ + +metastases) was taken into account; these events addedcisplatin cisplatin carboplatinextra costs of approximately 836 and 848 euros per (n = 293) (n = 292) (n = 290)

patient, or 8.3 and 8.4% of the total medical cost ofMedian survival (months):breast cancer, respectively. Over the 62-month period7.4 7.8 8.2the mean total cost of treatment and follow-up was 101-year survival (%):072 euros per patient, ranging from 2813 to 36 170

euros per patient. The researchers contend that their 31 31 35analysis has the advantage of providing per-patient cost Median time to disease progressionestimates suitable for a cost-of-illness study. (months):

Costs included those associated with hospital stay, 3.6 3.5 3.3medical staff, consultations, drugs and tests.

Partial response (%):

17 21 15Complete response (%):

0.4 0.3 0.3Total direct health costs (euros):

6418 8206 8522

* see Inpharma 1294: 3, 30 Jun 2001; 800817644

1. Sharplin P, et al. Modelling the cost-effectiveness of docetaxel in the secondline treatment of non-small-cell lung cancer. Value in Health 4: 433 (plusposter), Nov-Dec 2001.

2. Rubio Terres C, et al. Pharmacoeconomic analysis of advanced non-small celllung cancer treatment with docetaxel-cisplatin, paclitaxel-cisplatin andpaclitaxel-carboplatin. Value in Health 4: 436 (plus poster), Nov-Dec 2001.

3. Marchetti M, et al. First-line therapy for advanced breast cancer - cost-effectiveness of anastrozole versus tamoxifen. Value in Health 4: 433 (plusposter), Nov-Dec 2001.

4. Lilliu H, et al. Cost of treatment and follow up of breast cancer. A retrospectiveevaluation in a comprehensive cancer centre. Value in Health 4: 431-432 (plusposter) abstr. PCN2, No. 6, Nov-Dec 2001.

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