Cost effectiveness and tolerability of dose dense versus weekly paclitaxel chemotherapy in patients with early breast cancer: A real-world comparison.

Abstract

e18264 Background: Paclitaxel (PAC) regimens used in early breast cancer include 3-weekly, 2-weekly dose-dense (dd) and weekly regimens. Both dd x4 and weekly x12 regimens are superior to the 3-weekly x4 regimen, particularly in ER-negative disease. We set out to compare whether either regimen is superior to the other in terms of cost-effectiveness and tolerability. Methods: We conducted a retrospective case-control study in patients receiving adjuvant PAC for early breast cancer between 2010 and 2015. Patients who received weekly x12 PAC were matched to patients receiving dd x4 PAC by age and year of diagnosis. Data on costs were collected including costs of dayward visits, chemotherapy administration, hospitalization and pegfilgrastim (if used). Data on tolerability included dose delays, hospitalizations and early cessation of planned PAC therapy (with or without alternative chemotherapy). T-test was used to analyze continuous data and chi-squared test was used to analyze categorical data. Results: 38 patients were included in the analysis. Dayward costs were higher for weekly chemotherapy (mean cost €12,259 vs €6371, P < 0.0001), while pegfilgrastim costs were lower as expected in this group (mean cost €108 vs €4003, P < 0.0001). Total costs incurred during the treatment course were not significantly different (mean cost €13,322 vs €11,576, P = 0.23). There were no significant differences in the rate of hospitalization (3 vs 4) and dose delays (4 vs 3). The weekly group were more likely to stop or change treatment without completing the planned number of PAC cycles (0 vs 6 patients, P = 0.008). Conclusions: Weekly and dd PAC regimens are associated with similar overall treatment costs in this real-world setting. Patients receiving weekly chemotherapy are more likely to discontinue therapy early and/or switch to a different drug/regimen. In the absence of evidence for superior efficacy of one regimen over another, we favor the dose dense regimen.