Population-Based Pharmacoeconomic Model for Adopting Capecitabine/Docetaxel Combination Treatment for Anthracycline-Pretreated Metastatic Breast Cancer

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Abstract
Learning Objectives: After completing this course, the reader will be able to: Evaluate the combination of docetaxel and capecitabine compared with docetaxel alone for cost effectiveness. Categorize cost differences according to the costs of drugs, hospitalizations, consultations, and other expenditures. Appreciate how combining efficacy quality of life and cost to effectiveness data can be used to support decisions on health care. Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com Purpose. To model the cost-effectiveness of adopting capecitabine/docetaxel combination therapy in place of single-agent taxane therapy for women in the province of Ontario, Canada, receiving treatment for anthracycline-pretreated metastatic breast cancer. Methods. Clinical effectiveness and economic data were combined in a population model, from the perspective of a universal health care system. Estimates of clinical effectiveness and medical resource utilization were derived prospectively during a phase III randomized controlled trial comparing single-agent docetaxel with capecitabine/docetaxel combination therapy. Population data were obtained from the Cancer Care Ontario Registry and provincial prescription claims data. Results. During 1999–2000, 542 patients were eligible for taxane monotherapy. As capecitabine/docetaxel treatment confers a median 3-month survival benefit compared with docetaxel monotherapy, the projected survival gain in these patients was 136 life-years. The results of the cost-effectiveness analysis demonstrate that the survival benefit provided by the addition of capecitabine to single-agent docetaxel is afforded at a small incremental cost of Canadian $3,691 per life-year gained. Hospitalization costs for treatment of adverse events were less for patients receiving capecitabine/docetaxel combination therapy than for those receiving docetaxel monotherapy. The results were robust for adjustments in treatment costs and adverse effects costs. Conclusion. Due to its 3-month survival gain and small incremental treatment cost, capecitabine/docetaxel is judged to be a highly cost-effective treatment in anthracycline-pretreated advanced breast cancer. From the perspective of the Ontario health care system, the addition of capecitabine to docetaxel in this patient population is a clinically appropriate and economically acceptable treatment strategy.