Bates M, Tasch R, Williamson T, Zagari M; International Society of Technology Assessment in Health Care. Meeting.
Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 1997; 13: 137.
Technology Assessment Group, San Francisco, CA, USA.
OBJECTIVE: To determine the cost effectiveness of dexrazoxane as a cardioprotective agent in patients with stage IIIB or IV metastatic breast cancer treated with anthracyclines, in particular 5-fluorouracil, doxorubicin, and cyclophosphamide (FAC), in the US and Canada. METHODS: Using a Markov process, we developed a model for each country to estimate the cost of each cardiac event prevented and the cost of an additional life-year gained by using dexrazoxane. The models incorporated the direct medical costs of treating patients with chemotherapy and the costs associated with treating any cardiac events that occurred. We convened a panel of oncologists and a panel of cardiologists to describe the treatment patterns of patients receiving anthracycline-based chemotherapy in the US and Canada. Both models used clinical data from US clinical trials of FAC plus either dexrazoxane or placebo. Cost data for the US model were drawn from published sources, including the Red Book and the Physicians Fee & Coding Guide. For the Canadian model, costs were drawn from published fee schedules and a hospital costing model at the Chedoke/McMaster University Hospital in Hamilton, Ontario. RESULTS: Patients receiving FAC plus dexrazoxane after receiving 300 mg/m2 of doxorubicin experienced 27 cardiac events and survived an average of 29 months from the initiation of dexrazoxane treatment. Patients receiving FAC plus placebo experienced 70 cardiac events and survived an average of 15 months from this same time point. In the base case analysis for the US, we found that therapy with dexrazoxane costs US$5,662 per cardiac event prevented, and US$2,809 for each additional life-year gained. In Canada, these results were CDN$5,745 and CDN$2,856, respectively. These results were robust to sensitivity analyses conducted around key model variables. CONCLUSIONS: The cost-effectiveness ratios of using dexrazoxane to prevent anthracycline-induced cardiotoxicity in US and Canadian patients with stage IIIB or IV metastatic breast cancer fall with in the range of other generally accepted medical interventions. The use of dexrazoxane is slightly more cost-effective in Canada for several reasons: The unit costs of the resources used to treat these pateints are higher in the US (e.g. echocardiograms, hospitalizations, and chemotherapy outpatient visits); the price of dexrazoxane is higher in the US; and US physicians use more multiple-gated acquisition scans (a costly resource) than Canadian physicians. We conclude that the use of dexrazoxane is cost-effective for breast cancer patients receiving FAC chemotherapy beyond 300 mg/m2. Additional studies are needed to confirm these results in other patient populations or in other treatment scenarios.
Publication Types:
Keywords:
- Anthracyclines
- Antibiotics, Antineoplastic
- Antineoplastic Combined Chemotherapy Protocols
- Breast Neoplasms
- CAF protocol
- Canada
- Cost-Benefit Analysis
- Cyclophosphamide
- Doxorubicin
- Fluorouracil
- Heart Diseases
- Humans
- Neoplasm Staging
- Ontario
- Razoxane
- drug therapy
- economics
- therapy
- hsrmtgs
Other ID:
UI: 102233294
From Meeting Abstracts