Adjuvant cyclophosphamide, methotrexate, fluorouracil (CMF) in breast cancer - Is it cost-effective ?

Adjuvant chemotherapy (ACT) may expose patients to morbidity, with little n ain in outcome. Treatment with CMF (cyclophosphamide, methotrexate, fluorou racil) has been the standard ACT in several countries for decades. In this model, efficacy, tolerability and quality of life data from the English-lan guage literature were incorporated with Norwegian standard ACT practice and cost data in a cost-effectiveness/cost-utility approach. The CMF efficacy was calculated as 2.45 years saved per patient treated. The quality of life was assumed diminished by 0.33 (0-1 scale) for 6 months and the life years gained were valued Q = 0.86. An 85% dose intensity was employed, one Briti sh pound (pound 1) was calculated as 12 NOK and a 5% discount rate was used . The total cost of adjuvant CMF, including amounts spent on drugs, adminis tration, travelling and production loss, was calculated to pound 2365-pound 6253, depending on the method chosen. Money spent on drugs alone constitut ed 13-34%. The cost per life year saved was measured as pound 2170-pound 57 37. A cost-utility approach revealed a cost per quality-adjusted life year (QALY) of pound 2973-pound 7860. Adjuvant CMF in breast cancer is cost-effe ctive in Norway.