582Cost-effectiveness of AC-TH compared with TCH in new adjuvant therapy of breast cancer

Abstract

Abstract Background To analyze the cost-effectiveness of Doxorubicin/cyclophosphamide/Paclitaxel/trastuzumab (AC-TH) and Docetaxel/Carboplatin/trastuzumab (TCH). Methods A Markov model was built to simulate the process of breast cancer events and death occurred in both AC-TH and TCH armed patients and to choose a suitable chemotherapy method. Data were collected from the clinical trials, some publicized literatures and patients’ diaries of a large Chinese comprehensive hospital. The cost-effectiveness analysis of two regimens and sensitivity analysis were performed using a Markov model. Results We identified 41 breast cancer patients at Hangzhou First People’s Hospital, among whom 15 (60%) had a partial response for AC-TH treatment and 13 (81.25%) had a partial response for TCH treatment. No cardiac toxicity was observed. Hematologic grade 3 or 4 toxicities were observed in 1 of 28 patients. Nonhematologic grade 3 or 4 toxicities with a reverse pattern were observed in 6 of 29 patients. The mean QALY gain per patient compared with TCH was 0.25 with ACTH, while the incremental costs were $US 13,142. The incremental cost-effectiveness ratio (ICER) of AC-TH versus TCH was $US 52,565 per QALY gained. Conclusions TCH neoadjuvant chemotherapy was feasible and active in HER2-overexpressing breast cancer patients in terms of the pathological complete response, complete response, and partial response rates and manageable toxicities. Key messages breast cancer; neoadjuvant chemotherapy; pharmaceutical economics; Markov model; cost-effectiveness analysis.