Nab-paclitaxel weekly or q3w compared to docetaxel q3w as first-line therapy in patients with metastatic breast cancer: An economic analysis of a prospective randomized trial

Abstract

6592 Background: In patients with MBC, the current practice is first-line chemotherapy often with a taxane such as docetaxel. However, docetaxel is associated with dose-limiting toxicities. A nanoparticle albumin-bound (nab) formulation of paclitaxel was recently developed to overcome the safety drawbacks of docetaxel and to provide additional efficacy. A randomized phase II trial comparing nab-paclitaxel 100 or 150 mg/m2 weekly 3 out of 4 and nab-paclitaxel 300 mg/m2 q3w to docetaxel 100 mg/m2 q3w reported improved progression-free survival and reduced toxicity with the former regimens (Gradishar, 2008). To measure the economic value of the nab-paclitaxel regimens, an economic analysis from the perspective of the United Kingdom (UK) was conducted. Methods: The current study extracted data captured during the randomized trial. Resource utilization data contained within the database were converted into UK cost estimates. This consisted of costs for chemotherapy, drug delivery, patient monitoring, supportive care drugs, and hospitalization due to toxicity. Multivariate regression analysis was then conducted to compare the total cost of therapy between the four regimens. Results: Growth factor use, hospital days for side effects management, and toxicity-induced protocol discontinuations were higher in the docetaxel group. When all of the cost components were combined for the entire population (n = 300), patients in the nab-paclitaxel 100 mg/m2 weekly and 300 mg/m2 q3w groups had comparable costs to the docetaxel control (£15,396 vs. £15,809 vs. £12,923; p = NS). The nab-paclitaxel 150 mg/m2 weekly arm had significantly higher overall costs of £27,222 but was associated with a significant improvement in progression-free survival relative to docetaxel. As alternatives to docetaxel, the incremental cost per progression-free year gained with nab-paclitaxel 100, 150 mg/m2 weekly and 300 mg/m2 q3w were £5,600, £31,800, and £9,900 respectively. Conclusions: Given its more favorable safety profile, superior efficacy, and reasonable economic impact, nab-paclitaxel (weekly or q3w) can be a preferred option over docetaxel as first-line chemotherapy in MBC. [Table: see text]