Cost-effectiveness analysis of docetaxel (TaxotereA®) vs. 5-fluorouracil in combined therapy in the initial phases of breast cancer

The randomised controlled trial BCIRG001 has recently demonstrated that docetaxel in combination with doxorubicin and cyclophosphamide (TAC) has better efficacy than the standard treatment (FAC, i.e., 5-fluorouracil, doxorubicin and cyclophosphamide) in the adjuvant treatment of patients with node-positive breast cancer. The cost-effectiveness of TAC vs. FAC in the Spanish setting is analysed. Clinical outcomes from trial BCIRG001 were combined with Spanish costs and long-term efficacy of FAC and TAC extrapolated up to 5 years by means of a Markov model. Results are shown as cost per life year gained (C/LYG) and cost per quality-adjusted life year (C/QALY). Costs and effects were discounted at a rate of 3%. Mean survival was 17.8 and 16.5 years for TAC and FAC, with total costs of a,not sign14,611 and a,not sign11,586, respectively. The results of the cost-effectiveness analysis showed that TAC achieves a C/LYG and a C/QALY of only a,not sign2345 and a,not sign2631, respectively. Sensitivity analysis confirmed the robustness of the results. Combined therapy based on docetaxel (TAC) is not only an effective option, but also presents a favourable cost-effectiveness ratio, clearly below the Spanish efficiency threshold in all the scenarios considered.