Hostname: page-component-848d4c4894-2pzkn Total loading time: 0 Render date: 2024-05-01T16:12:56.169Z Has data issue: false hasContentIssue false
  • English
  • Français

COST-UTILITY ANALYSIS OF ADJUVANT THERAPIES FOR BREAST CANCER IN IRAN

Published online by Cambridge University Press:  13 April 2012

Peivand Bastani  and
Aliasghar Ahmad Kiadaliri
Peivand Bastani
Affiliation:
Tehran University of Medical Sciences
Aliasghar Ahmad Kiadaliri
Affiliation:
Lund University; Tehran University of Medical Sciences email: aliasghar.ahmad_kiadaliri@med.lu.se
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: The aim of this study was to evaluate the cost-utility of Docetaxel with doxorubicin and cyclophosphamide (TAC) and 5-fluorouracil, doxorubicin, cyclophosphamide (FAC) in node-positive breast cancer patients in the south of Iran.

Methods: A double blind study was done on a cohort of 100 patients suffering from breast cancer with node-positive over 8 months in the radiotherapy center of Namazi hospital, Shiraz-Iran. Health-related quality of life was assessed using questionnaire (QLQ-C30) from European Organization for Research and Treatment of Cancer (EORTC). QLQ-C30 scale scores were mapped to 15D and EuroQol 5D utilities to measure the quality-adjusted life-years (QALYs).Third party payer point of view was applied to measure and value the cost of treatments. Cost data were extracted from hospital and health insurance organizations. Robustness of the results was checked through a two way sensitivity analysis.

Results: TAC was associated with higher deterioration in HRQoL during treatment and higher improvements over 4 months follow-up. On average, the cost of treatment per patient in TAC was 15 times higher than FAC (p < .001). In overall, TAC was resulted in lower QALYs and higher cost over study period.

Conclusions: FAC was a dominant option versus TAC in short-term. The higher improvement in HRQoL over follow-up in TAC may not compensate the more intensive deterioration caused during treatment in short-term. The short time horizon of study may limit the generalizability of our findings and, hence, there is a need to conduct long-term economic evaluation studies whenever data is available to inform decision making.

Keywords

Cost-utilityQuality-adjusted life-yearsBreast CancerIran
Type
ASSESSMENTS
Information
International Journal of Technology Assessment in Health Care , Volume 28 , Issue 2 , April 2012 , pp. 110 - 114
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Aaronson, NK, Ahmedzai, S, Bergman, B, et al. The European Organisation for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85:365–376.CrossRefGoogle ScholarPubMed
2.Au, HJ, Golmohammadi, K, Younis, T, et al. Cost effectiveness analysis of adjuvant docetaxel, doxorubicin, and cyclophosphamide (TAC) for node- positive breast cancer: Modeling the downstream effects. Breast Cancer Res Treat. 2009;114:579–587.CrossRefGoogle ScholarPubMed
3.Bastani, P, Ahmad Kiadaliri, A. Health related quality of life after chemotherapy cycle in breast cancer in Iran. Med Oncol. 2011:28 (Suppl 1):S70–S74.CrossRefGoogle ScholarPubMed
4.Brooks, R. EuroQol: The current state of play. Health Policy. 1996;37:53–72.CrossRefGoogle ScholarPubMed
5.Early Breast Cancer Trialists’ Collaborative Group. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: An overview of the randomised trials. Lancet. 2005;365:1687–1717.CrossRefGoogle Scholar
6.Ferlay, J, Parkin, DM, Steliarova-Foucher, E. Estimates of cancer incidence and mortality in Europe in 2008. Eur J Cancer. 2010;46:765–781.CrossRefGoogle ScholarPubMed
7.Harirchi, I, Karbakhsh, M, Kashefi, A, et al. Breast cancer in Iran: Results of a multi-center study. Asian Pac J Cancer Prev. 2004;5:24–27.Google ScholarPubMed
8.Harirchi, I, Kolahdoozan, S, Karbakhsh, M, et al Twenty years of breast cancer in Iran: Downstaging without a formal screening program. Ann Oncol. 2001;22:93–97.CrossRefGoogle Scholar
9.Hatam, N, Ahmadloo, N, Ahmad Kiadaliri, A, et al. Quality of life and toxicity in breast cancer patients using adjuvant TAC (docetaxel, doxorubicin, cyclophosphamide), in comparison with FAC (doxorubicin, cyclophosphamide, 5-fluorouracil). Arch Gynecol Obstet. 2011;284:215–220.CrossRefGoogle ScholarPubMed
10.Kontodimopoulos, N, Aletras, VH, Paliouras, D, Niakas, D. Mapping the cancer-specific EORTCQLQ-C30 to the preference-based EQ-5D, SF-6D, and 15D Instruments. Value Health. 2009;12:1151–1157.CrossRefGoogle Scholar
11.Larsson, J, Sandelin, K, Forsberg, C. Health related quality of life and healthcare experiences in breast cancer patients in a study of Swedish women. Cancer Nurs. 2010;33:164–170.CrossRefGoogle Scholar
12.Lee, SG, Jee, YG, Chung, HC, et al. Cost effectiveness analysis of adjuvant therapy for node positive breast cancer in Korea: Docetaxel, doxorubicin, and cyclophosphamide(TAC) versus fluorouracil, doxurbicin and cyclophosphamide (FAC). Breast Cancer Res Treat. 2009;114:589–595.CrossRefGoogle Scholar
13.Martin, M, Lluch, A, Segui, MA, et al. Toxicity and health-related quality of life in breast cancer patients receiving adjuvant docetaxel, doxorubicin, cyclophosphamide (TAC) or 5-fluorouracil, doxorubicin and cyclophosphamide (FAC): Impact of adding primary prophylactic granulocyte-colony stimulating factor to the TAC regimen. Ann Oncol. 2006;17:1205–1212.CrossRefGoogle Scholar
14.Martin, M, Pienkowski, T, Mackey, J, et al. Adjuvant docetaxel for node-positive breast cancer. N Engl J Med. 2005;352:2302–2313.CrossRefGoogle ScholarPubMed
15.Mittmann, N, Verma, S, Koo, M, Alloul, K, Trudeau, M. Cost effectiveness of TAC versus FAC in adjuvant treatment of node-positive breast cancer. Curr Oncol. 2010;17:7–16.CrossRefGoogle ScholarPubMed
16.Mousavi, SM, Gouya, MM, Ramazani, R, et al. Cancer incidence and mortality in Iran. Ann Oncol. 2009;20:556–563.CrossRefGoogle ScholarPubMed
17.Naghavi, M.Epidemiology of mortality in 23 provinces of Iran 2003. Tehran, Iran: Ministry of Health, Deputy to Health Directory, Research and Development Office; 2005.Google Scholar
18.Rowen, D, Brazier, J, Roberts, J. Mapping SF-36 onto the EQ-5D index: How reliable is the relationship? Health Qual Life Outcomes. 2009;7:27.CrossRefGoogle ScholarPubMed
19.Sadjadi, A, Nouraie, M, Mohagheghi, MA, et al. Cancer occurrence in Iran in 2002, an international perspective. Asian Pac J Cancer Prev. 2005;6:359–363.Google ScholarPubMed
20.Sintonen, H. The 15D instrument of health-related quality of life: Properties and applications. Ann Med. 2001;33:328–336.CrossRefGoogle ScholarPubMed
21.Soinin, EJO, Garcia San Andres, B, Joensuu, T. Trabectedin in the treatment of metastatic soft tissue sarcoma: Cost-effectiveness, cost-utility and value of information. Ann Oncol. 2011;22:215–223.CrossRefGoogle Scholar
22.WHO. The global burden of disease: 2004 update. Geneva: World Health Organization.Google Scholar
23.Wolowacz, SE, Cameron, DA, Tate, HC, Bagust, A. Docetaxel in combination with doxorubicin &cyclophosphamide as adjuvant treatment for early node positive breast cancer: A cost effectiveness & cost utility analysis. J Clin Oncol. 2008;26:925–933.CrossRefGoogle ScholarPubMed