Cost-Utility of "Doxorubicin and Cyclophosphamide" versus "Gemcitabine and Paclitaxel" for Treatment of Patients with Breast Cancer in Iran.

Nahid Hatam,Javad Javan-Noghabi,Mehrdad Askarian,Mohammad Mohammadianpanah,Niloofar Ahmadloo

doi:10.7314/apjcp.2015.16.18.8265

Nahid Hatam, Javad Javan-Noghabi + Show 3 more

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https://doi.org/10.7314/apjcp.2015.16.18.8265

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Abstract

A cost-utility analysis was performed to assess the cost-utility of neoadjuvant chemotherapy regimens containing doxorubicin and cyclophosphamide (AC) versus paclitaxel and gemcitabine (PG) for locally advanced breast cancer patients in Iran. This cross-sectional study in Namazi hospital in Shiraz, in the south of Iran covered 64 breast cancer patients. According to the random numbers, the patients were divided into two groups, 32 receiving AC and 32 PG. Costs were identified and measured from a community perspective. These items included medical and non-medical direct and indirect costs. In this study, a data collection form was used. To assess the utility of the two regimens, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core30 (EORTC QLQ-C30) was applied. Using a decision tree, we calculated the expected costs and quality adjusted life years (QALYs) for both methods; also, the incremental cost-effectiveness ratio was assessed. The results of the decision tree showed that in the AC arm, the expected cost was 39,170 US$ and the expected QALY was 3.39 and in the PG arm, the expected cost was 43,336 dollars and the expected QALY was 2.64. Sensitivity analysis showed the cost effectiveness of the AC and ICER=-5535 US$. Overall, the results showed that AC to be superior to PG in treatment of patients with breast cancer, being less costly and more effective.

Highlights

Cancer is an important public health and economic concern around the world
Analysis of the EORTC-QLQ-C30 questionnaire in the symptom scales showed that the average score for the role and social functioning in AC arm was significantly higher than paclitaxel and gemcitabine (PG) arm
The purpose of this study was to evaluate the cost-utility of chemotherapy regimens containing doxorubicin and cyclophosphamide compared to Gemcitabine and Paclitaxel in patients with advanced breast cancer

Summary

Introduction

Cancer is an important public health and economic concern around the world. According to the World Health Organization report, over 22 million people in the world live with cancer and Global cancer incidence in 2004 was 11.4 million and this figure increases every year. Cancer is a second leading cause of death in the United States. Despite advances in the diagnosis of breast cancer, locally advanced breast cancer continues to be a major clinical problem, in developing countries (Papadimitriou et al, 2010) The incidence of this disease increases 1 to 2% per year in developed countries and 5% per year in less developed countries. In 2011, there were about 2.6 million breast cancer survivors in the United States and 39520 deaths have been estimated due to breast cancer in women in the U.S (Kolahdoozan et al, 2010). Based on the latest statistics announced by the Health Ministry of Iran, 27 people per hundred thousand women are diagnosed with breast cancer (Mohammadianpanah et al, 2012)

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