Cost effectiveness of treatment options in advanced breast cancer in the UK

Objective: To compare clinical and economic study data for docetaxel, pacli taxel and vinorelbine in the treatment of anthracycline-resistant advanced breast cancer. Study design and methods: A Markov decision-analysis model to simulate the clinical course of a 'typical' patient with advanced breast cancer during s alvage chemotherapy was updated with response rates and adverse effect rate s from phase III clinical trial data for docetaxel, paclitaxel and vinorelb ine. Costs were taken from UK national databases and hospitals. Utilities w ere estimated from 30 oncology nurses in the UK using the standard gamble m ethod. Perspective: National Health Service. Results: When compared with other chemotherapeutic agents, docetaxel has be en shown to increase response rate, time to progression and survival in pat ients with advanced breast cancer. In the base-case analysis, the increment al cost-utility ratio for docetaxel versus paclitaxel was pound 1995 per qu ality-adjusted life year (QALY) gained (1998 values). The incremental cost- utility ratio for docetaxel versus vinorelbine was pound 14 055 per QALY ga ined. In the comparison with vinorelbine, docetaxel provided the equivalent of an additional 92 days of per-feet health. Sensitivity analyses confirme d the robustness of the model and the validity of the base-case analysis re sults. Even in the worst case scenarios, docetaxel remained cost effective compared with paclitaxel and vinorelbine. Conclusions: These findings support the use of the taxoids, notably docetax el, in the management of advanced breast cancer.